TA 


/ 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

PRESENTED  BY 

PROF. CHARLES  A.  KOFOID  AND 

MRS.  PRUDENCE  W.  KOFOID 


r 


I 


ffik 


:ii 


DESCRIPTIVE,    DIAGNOSTIC     AND    PRACTICAL^ 

DISORDERS 

OF  THE 

DIGESTIVE  ORGANS  AND  GENERAL  HEALTH, 

AND    PARTICULARLY    OF    THEIR    Nl^EROUS 
FORMS  AJ^D  COMPLlCATIOJSrS, 

CONTRASTED   WITH   SOME 

ACUTE  JlJ>rn  IJ^SIDIOUS  DISEASES: 

1 

BEING  AN  ATTEMPT    TO    PROSECUTE  THE  VIEWS  OF 
DR.  HAMILTON  AND  MR.  ABERNETHY,  AND  A 

SECOND  EDITION 

OF    THE    ESSAY    ON    THE    MIMOSES, 
WITH    ADDITIONS. 


BY  MARSHALL  HALL,  M.  D.   F.  R.  S.  E.  &c.  &e. 


KEENE,  N.  H. 
PRINTED    AND    PUBLISHED    BY    JOHN    PRENTISS. 


1833. 


•  ■*» 


^. 


TO  "  / 

M.  D.  F.  R.  SS.  L.  AND  E. 
PHYSICIAN  EXTRAORDINARY  TO  THE  KING, 

^  ETC.     ETC.    ETCv 

SIR, 

TO  UR  indulgent  expression  of  approbation  of 
my  former  Work,  and  your  condescending  acceptance  of  the 
dedication  of  the  present  one,  constitute  at  once  the  most 
ample  reward  and  the  greatest  encouragement  of  my  efforts 
to  contribute  to  the  advancement  of  Diagnosis  and  the  His. 
tory  of  Diseases, 

JVith  every  sentiment  which  the  most  profound 
respect  can  inspire, 

I  remain  SIR, 

Your  most  obliged  Servant, 

MJiRSIMLL  HALL, 

Nottingham,  October  2lst,  18^0.. 


ii  o  K  T  i;  X  T  s , 


OJy  THE  MIM08ES, 


§§  1,  2 
4 


The  General  Character, 
Origin  of  the  Term,      .         .         . 
The  principal  Forms  of  the  Mimoses, 
The  Complications, 
The  Object  of  this  Essay,     . 
The  Nature  of  these  Afiections,     . 
Their  Causes,       .... 
And  Pathology,   .... 

Anology  for  the  introduction  of  a  new  denomination  ,  ^^ 
for  them.       ...  J^  i- 


7 
8 
9 

10—13, 
14—1.7 


CHAPTER  L 

OJV  THE  MIMOSIS  JiCVT^. 

SECTION  I.   Description,  with  cases. 
The  General  Character, — of  the  Severe  and  Less  > 


Severe  Forms. 
List  of  Complications, 
Description, 
Cases, 
History, 
Weight  of  Patients, 


>  24,    39 

34,  41,  150,  153 

25 — 42 

44_5S 

59_64 

.  p.  45,  a  note 


SECTION  II.     The  Diagnosis,  with  cases. 

I.   The  Diagnosis  of  the  General  Affection-, 

1.  From  Fevers, ^^ — 70 

2.  From  Organic  Disease,    .         .         .         .         71,    72 

3.  From  Strumous  Disease  of  the  Mesentery  in^  ^^ „- 


Adults 
4.  From  an  Effect  of  Drunkenness, 


f6 


CONTENTS. 


II.  The  Diagnosis  of  the  Complicatioiis. 

1.  With  Affection  of  the  Head, 

1.  of  an  Apoplectic,        .         .         .  .          83,  84 

».  of  an  Eliptic  character,       .         .         .         85 88 

3.  Pain  and  some  other  Affections,  .         89 — 94 

2.  With  Affection  of  the  Chest, 

1.  Oppressive  Dyspnoea,         .         .         .         qq 93 

2.  Cou^h  with  Expectoration,        .  .       99 — 105 

3.  With  Affection  of  the  Heart, 

1.  Fluttering  palpitation,  irregular  action}  ,^^     , , ,, 

2,  Fainting, 5  106— lU 

4.  With  Affections  of  the  Stomach  and  Bowels, 

1.  Hiccough, 115—120 


2.  Haematemesis,  Melaena, 

3.  Pain,     .... 

4.  Constipation,  Diarrhoea, 
5.  With  Icterus, 


121 
122—125 

126—127 
...    128-131 

6.  With  Symptoms  of  affection  of  the  Bladder,        132 

7.  With  Pain  resembling  the  Tic  Douloureux,  133 

8.  With  Convulsive  and  Spasmodic  Affections    135 — 144 

9.  With  Paralytic  Weakness,  .         .         145—146 
10.  With  a  singular  Tumidity  of  the  face  and}  ,  ,„     ^.- 

General  Surface,        .         .         .         .     ^  14/— 149 

III.  The  Local  Complications, 

1.  An  Arid  and  Exfoliating  state  of  the  Prola^ia,    151 

2.  An  Ulcerated  state  of  the  Tongue,         .         .         152 

IV.  A  Cachectic  Form  of  Mimosis,      .        ^        153: 157 

SECTION  III.     The  Causes  and  Treatment. 

1.  Of  the  General  Affection,     .         .         .         153 174 

2-.  Of  the  Complications,  .         .         .         175 xg..'? 


CHAPTER  IL 
<?JV  THE  MIMOSIS  CHROXICJJ. 

SECTION  I.     The  Description. 

The  General  Character, 185 

The  Description, j8(j 194 


CONTENlS. 

SECTION  II.     The  Diagnosis. 

1.  From  the  Less  Severe  Form  of  the  Mimosis  Acuta,  19(r 

2.  From  Insidious  Organic  Disease,    .         .         .         197* 
SECTION  III.  The  Causes  and  Treatment,       19S— 203 


CHAPTER  III. 

OJV  THE  MLMOSIS  DECOLOR. 

SECTION  I.     The  Description,  with  Cases. 


The  General  Character, 

Description  of  the  Inci- 
pient, Confirmed,  and 
Inveterate  Forms  or 
Stages, 

And  of  the  Chronic  Form, 

Of  some  Varieties,    . 

As  it  occurs  in  Married  Persons 

And  in  the  Male  Sex, 

From  Haemorrhagy, 

List  of  Complications, 

Pathological  Remark, 

Cases, 

History, 

Remedies, 

Dissection, 


205 


>208— 214;  215— 222  ;  223,  250 


229—235,  253 

225,  243—246 

236,  256—259 

260—262 

248 

226 

228 

238—262 

263—265 

235 

.      .    *  266 


SECTION  IL     The  Diagnosis,  with  Cases. 

I.  The  Diagnosis  of  the  General  Affection, 

1 .  From  Insidious  Organic  Disease,     . 

2.  From  Disease  of  the  Liver,  '^ 

II.  The  Diagnosis  of  the  Complications, 

1.  With  Sudden  Affection  of  the  Head,    . 

2.  With  Continued  affection  of  the  Head, 

3.  With     Sudden  or  Continued  Cough  and^    ^-^   ^g^ 
Dyspnoea,         .....  S  ' 

4.  With  Palpitation  of  the  Heart,  :  .  .  281 
With  Sudden  Pain  and  Tenderness  of  the  Side,  282,  283 
With  Protracted  pain  of  the  Side,       .         .         284,  285 


^ 

26S 

• 

269 

271- 

-275 

276- 

-278 

CONTENTS. 


With  Sudden,   or   Protracted,   Pain   of  the^  ^g^ ^gs 

Abdomen,  .....  ^  ^         ^ 

WithMelsena,  .....         289—291 

With  Menorrhagia  and  Leucorrhoea,'  .         .  292 

SECTION  III.     The  Causes  and  Treatment. 


CHAPTER  IV. 

OJV  THE  MIMOSIS  URGEJ^S. 

SECTION  I.     The  Description. 

The  General  Character,     ....  307,  324 

OftheMild,  Severe,  >  3JQ     311—322,   329;  323,  330 

&  Inveterate  Forms,  3  ' 

Copious  List  of  the  other  Forms,        .         .  .  325 

Section  II.     The  Diagnosis*  ^ 

1.  Of  the  Convulsion, 333 

2.  Of  the  Affections   of  the  Head, — Pain,  >  oq^ qoo 

Delirium,  Stupor,  &c.     ...  5 

3.  Of  Pain  of  the  Chest,  ....         339 

4.  Of  Urgent  Dyspnoea,  ....         340 

5.  Of  Fits  of  Coughing, 241 

6.  Of  Suspended  Respiration,     ....         343 

7.  Of  a  painful  Affection  of  the  Diaphragm,        344 — 345  M 

8.  Of  the  Imitation  of  Croup,  .         ,  346,  347  *^ 

9.  Of  the  Palpitation  or  Syncope,        ...         348 

10.  Of  the  Pain  of  the  Abdomen,         .         .         349,  350 

11.  Of  the  Hiccough  or  Retching,         .         .         .         351 

12.  Of  the  Dysury, 352 

13.  Of  the  Partial  Paralysis,         ....         353 

14.  Of  the  Trismus,  Tetanus,  Clenched  Hand,  >  0^4 okr 

Contracted  Foot,  Twisted  Legs,  &c.         > 
Remark,  .357 

SECTION  IIL     The  Causes  and  Treatment,    358—361 

POSTSCRIPT. 
OJV  THE  MIMOSIS  JXqVIETJi. 


ADVERTISEMENT. 


/  have  changed  the  Title-page  of  this  little  work^  hut 
have  retained  the  term  Mimosis  in  the  Text.  The  reader 
tvill  adopt  or  reject  it  as  lie  deems  most  proper.  I  still  think 
it  the  most  appropriaie  in  itself  and  the  most  useful  in  its 
practical  tendency. 

The  present  Essay  describes  the  various  affections  of 
the  General  Health  and  of  different  Parts,  which  arise 
from  the  more  continued  action  of  Derangement  of  the 
Digestive  Organs.  The  Essay  alluded  to  in  the  Postscript , 
p.  191,  displays  the  more  acute  and  alarming  effects  of  In- 
A  testinal  Load  and  Irritation,  and  of  Exhaustation  from 

Loss  of  Blood,  or  other  Causes.  These  two  Classes  of  Mor- 
bid Affections  ere,  as  the  reader  will  observe,  allied  in  many 
respects. 

M.   H. 


ON    THE 


MIMOSES 


1.  THERE  is  a  Class  of  Disorders,  each  of 
which  consists  of  a  more  general  morbid  affection, 
usually  combined  with  some  topical  symptom  or 
symptoms. 

2,  The  general  affection  is  complex  and  various  5 
the  complications  are  multiform  and  changeable,  and, 
by  their  incidental  predominence,  frequently  imitate 
other  diseases  widely  different  in  their  nature. 

3.  These  affections  have  been  variously  and  per- 
haps too  exclusively  attributed,  by  some  authors,  to 
a  state  of  derangement  in  one  or  more  of  the  chylo- 
poetic  viscera :  and  by  others,  to  an  unequal  and 
undue  distribution  of  the  blood,  by  which  a  state  of 
arterial  excitement  or  of  venous  congestion  is  induced 

B 


10  ON  THE  MIMOSES. 

in  some  particular  organ,  or  in  some  particular  part 
of  the  sanguiferous  systenu  1  have  scarcely  ventured 
in  this  work,  to  enter  into  any  speculation  relative  to 
the  pathology  of  the  affections  of  which  it  treats  :  for 
this  part  of  medicine,  notwithstanding  the  ingenuity 
of  some  late  theorists,  seems  scarcely  to  have  advanced 
from  the  state  of  conjecture  and  uncertainty  described 
by  Celsus,  whose  words*  are  still,  in  every  sense,  but 
too  admissable. 

4.  As  the  real  nature  and  connexion  of  the  general 
and  tojHcal  affections,  in  tjiese  complaints,  may  thus 
frequently  be  dubious,  1  have  deemed  it  advisable  to 
appropriate  some  new  term,  which  might,  without 
implying  any  opinion  on  the  subject,  sufficiently  ex- 
press a  prominent  and  important  feature  of  this  class 
of  morbid  affections.  The  denomination  MIMOSIS, 
from  the  Greek  word  Mimos,  imitator,  v/\\\  at  once  de» 
note  a  remarkable  peculiarity, — the  multiform  charac- 
ter,— of  these  disorders,  and  will  serve  to  impress 
the  mind  with   the   necessity  of  distinguishing,   in 


*  Cum  hxc  per  multa  voiumtna,  perque  inagnEe  contenlionis  disputantiones,  a 
njedicis  scspe  ti-actata  sint  atquc  tractentur  ;  subjiciendum  est,  quis  proxima  vei'o 
videri  possint.  Ea  neque  addicta  altorutri  opiiiioui  sunt,  neque  ab  utraque  nimium 
abhorrentia  ;  media  quodammodo  inter  diversas  sentsntias :  quod  in  plurimis  coa" 
tentionibus  deprehendere  licet,  sine  ambitione  verum  scrutantibus,  ut  in  hac  ipsa- 
re.  Nam  quse  dcmum  causse,  vel  secundam  valatudinem  praestent,  vel  morboa 
excitent,  ne  sapientiae  quidera  professores  scientia  comprehendunt,  sed  conjectura 
persequuntur.  Cujus  autem  rei  non  esteerta  notitia,  ejus  opinio  eertnm  reperire 
remedium  non  potest.  Veruroque  est,  ad  ipsam  curandi  rationem  nihil  plus  ©on- 
fcrre,  quam  experientiam.— Celsi  Prjet. 


ON  THE  MIMOSES.  li 

Local  Affections,  between  those  which  belong  to  the 
present  Class,  and  others  which  are  either  primary, 
or  have  a  different  origin, — a  point  of  great  practical 
importance. 

5.  For  a  similar  reason,  I  have  discarded  th«  terms 
bilious,  spasmodic,  &c.  as  denominations  for  disea- 
ses ;  and  have  reserved  them  only  to  denote  certain 
tsYMPTOMS  of  morbid  affections.  In  the  latter  sense, 
their  import  is  generally  understood,  and  may,  per- 
haps,  be  sufficiently  definite ;  but  in  th«  former,  they 
could  only  serve  to  satisfy  the  mind  with  vague  con- 
ceptions of  the  affection,  and  to  check  the  investiga- 
tion of  its  particular  and  individual  nature.* 

6.  Of  the  Mimoses  1  have  observed  five  forms  ; 
— ^the  Mimosis  Acuta,  the  Mimosis  Chronica,  the 
Mimosis  Decolor,  the  Mimosis  Urgens,  and  the  Mi- 
mosis Inquieta, 

I.  The  Mimosis  Acuta  appears  to  me  not  to  haVe 
been  more  fully  described  in  medical  writings,  un- 
less this  affection  be,  as  I  suspect,  indentical  with  the 
Scorbutus  of  Willis  and  other  writers  of  his  day.f 

II.  The  Mimosis  Chronica  is  the  Dyspepsia  or  Hy- 
pochondriasis of  medical  authors. 

*  See  the  author's  Treatise  on  Diagnosis,  pp.  x,  2 — 3.  .» 

t  See  the  Edinb.  Med.  and  Surg.  Journal,  Vol.  16,  p.  204;  qn  the  acceptation 
vof  the  Term  Scobbutu^. 


i^  ON  THE  MIMOSES. 

III.  The  Mimosis  Decolor  embraces  the  Chlorosis 
of  medical  writers,  together  with  some  other  morbid 
affections,  in  which  the  complexion  and  general  sur- 
face suffer  materially,  and  which  have  not,  I  think, 
been  hitherto  sufficiently,  if  sd  all  distinctly  described. 

IV.  The  Mimosis  Urgens  is  the  Hysteria  of  authors. 
Its  numerous  forms  are,  I  think,  more  amply  collected 
and  described  in  this  than  in  any  former  publication. 

V.  The  Mimosis  Inquieta  is,  I  believe,  described 
in  this  work  for  the  first  time.  It  appears,  in  gene- 
ral, to  combine  the  effects  of  intestinal  irritation  and 
of  cxhaustation  from  loss  of  blood  or  other  causes.* 

7.  The  COMPLICATIONS  of  the  Mimoses  are  apt 
to  be  mistaken  and  mistreated  for  different  Inflamma- 
tory and  other  Local  diseases,  and  appear  to  me  to 
constitute  a  Class  of  morbid  affections  scarcely  less 
frequent  or  less  important,  and  requiring  to  be  distin- 
guished with  the  utmost  care.  For  an  enumeration 
of  these  complications  the  reader  is  referred  to  the 
table  of  Contents. 

8.  The  object  of  this  Essay  is  to  establish  this 
Class  of  general  and  local  morbid  affections  more  dis- 

•  Since  the  appearance  of  the  first  edition  of  this  Essay,  I  have  published  a 
separate  tract  on  this  subject,  with  the  following  title  : — Cases  of  a  Serious  Mor- 
bid AfFeciion,  chiefly  occurring  after  Deliveiy,  Miscarriage,  &c.  from  vai-ions  cau- 
ses of  Irritation  and  Exhaustation ;  and  of  a  Similar  Affection,  unccnnerted  with 
the  Puerirei'al  State. 


ON  THE  MIMOSES.  13 

tinctly  and  extensively  than  before, — to  collect  and 
embody  the  system  of  facts  which  belong  to  this  part 
of  pathology, — to  present  accurate  descriptions  of 
the  different  forms,  and  to  trace  the  diagnosis  of  the 
numerous  complications  of  these  disorders. 

« 

9.  I  have  thus  been  very  explicit  as  to  the  design 
and  pretensions  of  this  little  Essay,  With  regard 
to  the  NATURE  of  these  affections,  I  beg  to  observe 
that  I  consider  them  all  as  similar.  The  Mimosis 
Acuta  differs  from  the  Mimosis  Chronica,  in  affecting 
the  process  of  assimilation,  the  strength,  and  the  gene- 
ral health,  more  seriously.  The  Mimosis  Decolor 
presents  some  extraordinary  states  of  the  complexion, 
the  general  surface,  and  the  capillary  circulation,  the 
cause  remaining  probably  similar.  The  Mimosis  Ur- 
gens  is  not  necessarily  connected  with  any  of  these 
affections  of  the  assimilation  or  of  the  surface,  and  yet 
the  cause  may  still  be,  in  a  general  sense,  the  same. 
The  Mimosis  Inquieta  conjoins,  with  this  cause,  the 
state  of  exhaustation. 

10.  Too  much  praise  cannot  be  conferred  on  those 
members  of  the  profession,  who  have  so  well  elucidated 
the.  nature  and  treatment  of  some  of  the  subjects  of 
the  preceding  pages.  There  is  no  doubt,  indeed,  that 
this  investigation  of  the  Mimoses  was  suggested  to  me 
by  what  I  have  learnt  from  the  invaluable  labours  of 
Dr.  Hamilton,  Mr.  Abernethy,  and  other  re- 
spectable writers.     My  situation  in  Nottingham,  how- 


14  ON  THE  MIMOSES. 

ever,  has  been  a  principal  cause  of  ixing  my  attention 
on  a  Class  of  Disorders,  of  which  the  usual  causes  aic 
sedentariness  and  coniinement.  This  town,  so  cele- 
brated for  its  manufactories  of  cotton  stockings  and 
lace,  embraces  a  very  extensive  population,  a  great 
majority  of  which, — men,  women,  and  children, — 
are  engaged  from  morning  till  evening,  in  the  numer- 
ous sedentary  occupations  which  these  manufactories 
imply, — deprived  of  the  salutary  influence  of  pure  air 
and  gentle  exercise. 

11.  To  these  numbers,  which  are  peculiar  to  my 
situation,  must  be  added  the  sedentary  amongst  the 
remaining  part  of  the  population, — the  literary,  per- 
sons of  a  delicate  mode  of  life,  females  in  general, 
tailors,  mantua-makers,  and  the  youthful  inhabitants 
of  the  schools. 

IS,  Nor  is  sedentariness  the  only  cause  of  the  Mi- 
moses,  the  operation  of  which  is  peculiarly  frequent 
amongst  the  poor  of  Nottingham.  I  have  noticed  the 
frequent  occurrence  of  the  Mimosis  Decolor  in  cooks 
^nd  housemaids ;  and  the  same  remark  applies  equally 
to  those  persons  Avho  are  much  engaged  in  ^  ironing,' 
and,  of  consequence,  much  confined  to  an  atmosphere 
overheated  by  stoves  for  the  purpose  of  quickly  dry- 
ing the  articles  subjected  to  this  process. 

13.  To  this  view  of  the  causes  of  the  Mimoses  pe- 
culiar to  a  manu£acturing  town,  may  be  added  the 


ON  THE  MIMOSJES.  i& 

baneful  influence  of  a  confined  and  impure  atmosphere, 
and  an  indigestible  and  poor  diet, — an  influence  which 
we  learn  lo  estimate  more  perfectly,  by  adverting  to 
the  impediment  they  afford  to  our  attempts  to  cure, 
and  to  the  beneficial  effects  of  the  country  air  and 
exercise,  with  a  proper  and  nutritious  diet. 

14.  A  certain  activity  of  the  body  would  appear 
to  be  necessary  to  insure  the  peristaltic  movements  of 
the  intestines,  and,  in  consequence,  the  propulsion  of 
their  contents.  During  sedentariness,  these  move- 
ments are  probably  retarded,  the  alvine  evacuation 
becomes  more  scanty  or  less  frequent,  and  the  intes- 
tines remain  loaded. 

15.  From  this  loaded  state  of  the  bowels,  their 
functions,  and  those  of  all  the  chylopoetic  viscera, 
most  probably  become  deranged.  The  alvine  con- 
tents become  disordered  merely  by  delay ;  and  their 
presence  induces  in  its  turn,  a  disordered  state  of  the 
functions, — or  actions, — of  all  the  organs  contributory 
to  digestion,  and  at  length  of  other  organs  more  re- 
motely situated  in  the  animal  frame. 

16.  The  functions  of  the  parts  within  the  mouti^ 
become  obviously  disordered.  The  secretions  become 
morbid  ;  the  tongue  becomes  loaded  and  swollen  ;  the 
gums  red  and  tumid;  the  breath  tainted;  and  the 
saliva  sometimes  profuse  and  offensive.  The  com- 
plexion   and  the   skin  become   morbid,    and   there 


16  ON  THE  MIMOSES. 

tire  the  appearances  observed  in  the  Mimosis  Acuta 
or  the  Mimosis  Decolor,  and  frequently  cederaa.  Thi» 
condition  of  the  complexion  and  skin  varies  with  the 
state  of  the  original  disorder,  and  with  that  of  the 
tongue  and  internal  mouth,  of  which  it  affords  indeed 
an  INDEX.  With  the  state  of  the  mouth  and  skin, 
that  of  the  secretions  and  other  functions  of  the  whole 
course  of  the  ALIMENTARY  CANAL  and  the  contribu- 
tory digestive  organs, — the  liver,  the  pancreas, 
&c.  may  be  presumed  to  be  all  morbidly  affected. 
Digestion  is  variously  deranged  ;  the  contents  of  the 
bowels  become  unnatural ;  and  thus  reciprocally.  Ac- 
cording to  the  state  of  things,  nutrition  is  impaired, 
or  the  sensations  are  uneasy  and  painful. 

17.  To  term  these  disorders  stomachic,  intestinal, 
hepatic,  or  bilious,  would  alike  afford  partial  and  in- 
adequate views  of  this  comprehensive  subject.  As 
co-existant  or  subsequent  links  of  this  chain  of  sym- 
pathies, the  functions  of  the  brain,  heart,  respi- 
ration,   STOMACH,     intestines,   UTERUS,    BLADDER, 

Etc,  become  variously  affected.  The  muscular 
SYSTEM  and  the  senses  also  suffer  in  different  instan- 
ces. And  nutrition,  absorption,  and  secretion  are 
impeded  or  impaired. 

18,  From  this  view  of  the  subject,  the  character 
of  the  Mimoses  may  be  deduced.  And  the  recur- 
rence of  this  word,  leads  me  once  more  to  apologize 
for  the  introduction  of  a  new  denomination  for  these 


ON  THE  MIMOSES.  17 

-diseases.  I  have  been  induced  to  adopt  this  term, 
first,. to  prevent  a  great  deal  of  circumlocution ;  and, 
secondly,  because  I  could  find  no  other  in  use,  which 
v^^as  not  objectionable  from  implying  some  hypotheti- 
cal view  of  the  subject.  These  motives,  I  still  trust, 
will  appear  sufficient  to  justify  the  innovation.  I  can 
at  least  assert  in  the  words  of  Morgagni, — longe 
mihi  potior  cura  est  veritatis  quam  novitatis. 

19.  It  was  originally  intended  to  publish  tlie  fol- 
lowing Essay  in  a  larger  form,  accompanied  by  repre- 
sentations of  the  Complexion,  Tongue,  Tinge  of  Sur- 
face and  of  the  Hands.  It  is  now  found  necessary, 
however,  to  leave  the  task  of  procuring  plates  to  some 
one  more  fortunately  situated,  or,  at  least,  to  a  subse- 
quent period.  In  the  mean  time,  the  text,  it  is  hoped, 
will  be  found  a  faithful  portrait  from  Nature,  not  un- 
acceptable to  the  reader  of  practical  medicine. 

SO.  Before  I  conclude  these  few  preliminary  re- 
marks, I  may  be  allowed  to  observe,  that  there  is  in 
tiic  profession  a  two-fold  prejudice,  respecting  medi- 
cal investigations  : — whilst  one  class  of  practitioners 
seem  inclined  to  refer  too  many  morbid  affections  to 
a  deranged  state  of  the  chylopoetic  organs,  another, — 
'  contrarium  errorem  errantes,' — turn  their  attention 
too  exclusively  to  such  diseases  as  leave  traces  under 
the  scalpel  of  the  anatomist.  Both  parties  appear  to 
be  in  the  wrong ;  each  of  these  topics  deserves  and  de- 
mands its  due  share  of  attention.  The  important 
c 


18  ON  THE  MIMOSES. 

study  of  DIAGNOSIS  seems  to  be  that  by  which  alone 
wc  may  be  safely  piloted  through  these  opposite  dan- 
gers.— I  trust  the  following  pages  will  serve  to  illus- 
trate the  force  and  truth  of  this  remark. 


f  ' 


CHAPTER  I. 


THE  MIMOSIS  ACUTA. 


SECTION  I.    DESCRIPTION  WITH  CASES. 

^l.  FllOM  the  great  diversity  and  complication 
of  the  symptoms  of  this  form  of  Mimosis,  and  from  the 
occasional  prevalence  of  one  particular  symptom  over 
the  rest,  it  is  probable  that  it  has  sometimes  been 
mistaken  for  some  other  affections.  With  the  view  of 
assisting  the  distinction  of  this  case  in  future,  it  will 
be  my  object,  first  to  detail  tUe  symptoms  which  char- 
acterize the  complaint  in  general,  and  in  the  second 
place,  to  enumerate  those  particular  symptoms  which 
are  apt,  in  certain  instances,  to  engross  the  attention 
of  the  patient  and  of  his  friends,  and  even  to  occasion 
some  difficulty  and  cmbarrasment  in  the  diagnosis,  to 
the  medical  practitioner* 

22.  In  order  to  facilitate  the  description,  the  Mi- 
mosis  Acuta  will  be  considered  under  tv\^  forms,  dif- 
fering only  in  degree, — in  the  greater  or  less  severity 
of  its  symptoms  in  general, — and  in  the  presence  or 
absence  of  some  of  the  severer  symptoms.  These  two 
forms,  of  course,  sulmit  of  aU  intei*mediate  shades  ; 


20  THE  MIMOSIS  ACUTA. 

they  are  also^  each,  apt  to  be  continued  in  a  protract- 
ed form. 

^3.  The  Mimosis  Acuta,  even  in  its  severer  form, 
comes  on  insidiously,  and  tbe  patient  gradually  be- 
comes incapacitated  for  business  or  his  usual  exercise  : 
the  less  severe  form  occurs  more  gradually  and  insidi- 
ously still. 

21.  The  severer  form  of  the  Mimosis  Acuta  is  early 
and  principally  characterized  and  distinguished  by 
the  concurrence  of  the  following  symptoms, — namely, 

WEAKNESS,  TUEMOR,  HEADACH,  VERTIGO,  FLUTTER- 
ING, FAIXTISHNESS,  TENDENCY  TO  PERSPIRATION, 
SUSCEPTIBILITY  TO  HURRY  AND  AGITATION,  WEARI- 
NESS, AND  LOSS  OF  FLESH. 

25.  The  countenance  is  rather  pale  and  thin;  the 
lips  are  pale,  and,  with  the  chin,  frequently  tremu- 
lous, especially  on  speaking  ;  the  surface  of  the  face  is 
generally  affected  with  an  appearance  of  oily,  clam- 
my, and  swarthy  perspiration,  especially  near  the 
nose ;  there  is  a  loss  of  coloiir,  and  usually  a  degree 
of  sallowness  and  darkness  of  the  complexion  in  ge- 
neral, bat  principally  about  the  eyes.  The  faoe  is 
often  bloated,  and  the  skin  coarse,  at  first;  after- 
wards, there  is  some  degree  of  emaciation. 

26.  The  tongue  is  almost  invariably  loaded  : — 
sometimes  only  slightly,  whilst  its  edges  are  clean 


DESCRIPTION,  WITH  CASES.  ^ 

and  red ; — in  severe  cases,  a  load  has  formed  over  the 
ton§ue,  und  has,  almost  at  once,  peeled  oif,  leaving 
the  surface  morbidly  red,  smooth,  and  tender; — at 
other  times  it  is  more  loaded,  swollen,  and  oedematous, 
formed  into  deep  sulci  or  plaits,  and  marked  by  pres- 
sure against  the  contiguous  teeth, — the  inside  of  the 
cheeks  being  also  impressed  in  the  same  manner ;  the 
papillae  of  the  tongue  are  numerous  and  enlarged  ;  the 
gums  are  red  and  swollen,  and  occasionally  bleed :  the. 
teeth  and  the  mouth  are  in  general  foul,  and  the  breath 
loaded  and  foetid ;  in  a  fourth  instance,  the  tongue 
may,  however,  be  clean,  but  lobulated,  whilst  the  in- 
ternal mouth  and  breath  are  little  affected.  The  first 
and  second  states  of  the  tongue  are  observed,  when 
the  affection  has  not  continued  long ;  tlie  third,  when 
its  accession  has  been  particularly  slow  and  gradual ; 
and  the  fourth,  when  a  similar  but  chronic  state  of 
disorder  has  long  subsisted,  and  has,  at  length,  been 
succeeded  by  the  Mimosis  Acuta. 

S/.  There  is  a  tendency  to  perspiration,  on  slight 
exertion,  or  any  surprise,  and,  sometimes,  in  the  night 
or  early  in  the  morning  ;  the  skin  is,  in  general,  cool, 
rather  moist,  and  clammy  ;  in  some  protracted  cases, 
it  has  become  dry  and  harsh.  The  hands  and  feel 
are  apt  to  be  very  cold,  and  the  nails  occasionally  as 
sume  a  lilac  hue. 

S8.  The  patient  is  usually  affected  with  great  tre- 
mor, observed  sometimes  in  a  quivering  of  the  lip,  or 


M  THE  MIMOSIS  ACUTA. 

dimpling  of  the  chin,  but  more  usually,  on  holding 
out  the  hand,  or  in  carrying  a  cup  of  tea,  for  instance 
to  the  mouth,  on  attempting  to  stand  erect  or  walk, 
or  on  being  fatigued  or  hurried.  The  tremor,  in 
some  protracted  cases,  has  formed  the  most  remarkable 
feature  of  the  affection ;  in  otherfe,  it  has  been  much 
less  observed,  but  it  is  rarely,  if  ever,  entirely  absent. 
The  patient  is  liable  to  experience  faintishness  in  the 
lipright  position,  if  sustained  for  a  little  time.  And 
he  feels  unaccountably  feeble  and  weary,  and  suffers 
from  a  sense  of  aching,  after  slight  exertion. 

29.  There  is  an  early  and  daily  loss  of  flesh.  Tiiis, 
as  well  as  the  restoration  of  flesh,  during  recovery, 
may  be  ascertained  by  weighing,  as  exemplified  in 
some  of  the  cases  of  this  affection,  to  be  given  here- 
after. 

30e  The  patient  experiences  head-ach  and  ver- 
tigo, and  he  is  nervous,  and  easily  hurried  and  agi* 
tated.  There  is  sometimes  heaviness  for  sleep  ;  some- 
times great  wakefulness  and  restlessness  ;  sometimes 
incubus,  rarely  delirium  5  sometimes  loss  of  memory 
and  absence  of  mind.  Tiiere  is  almost  universally  a 
peculiar  sense  of  fluttering  about  the  heart  and  pit  of 
the  stomach.  And  there  is  frequently  an  acute  pain 
in  some  part  of  the  course  of  the  colon. 

31.  The  pulse  is  generally  nearly  natural,  but  it 
is  often  rather  frequent,  and  usually  easily  accelerat- 


DESCRIPTION,  WITH  CASES.  S8 

e'd.     There  are  often  great  irregularity  and  intermit - 
teiice  of  the  pulse. 

3S.  The  appetite  is  generally  much  impaired,  and 
there  is  often  loathing  of  food ;  but  sometimes  the 
appetite  is  even  greater  than  natural,  and  there  is 
almost  constant  craving.  The  digestion  is  various, 
being  sometimes  quick,  and  at  other  times  attended 
M^ith  great  sense  of  load,  distention,  flatus,  eructation, 
hiccough,  and  even  rumination  or  vomiting  of  food. 
The  bowels  are  at  first  constipated  5  afterwards  con- 
stipation and  diarrhoea  alternate,  and  sometimes  the 
latter  symptom  becomes  nearly  permanent :  the  mo- 
tions, during  the  constipation,  are  small,  during  the 
diarrhoea,  scanty,  extremely  foetid,  dark  coloured, 
often  accompanied  by  blood,  and  frequently  attended 
by  tenesmus. 

33.  The  urine  is  extremely  loaded  in  the  com- 
mencement of  the  MiiQpsis  Acuta,  but  may  become 
perfectly  transparent  during  its  continuance ;  it  is 
often  high  coloured  ;  and  like  the  other  symptoms  the 
appearance  of  this  secretion  is  very  liable  to  change. 
A  continued  state  of  Minu)sis  seems  to  lead  to  the  for* 
mation  of  gravel. 

34.  Besides  the  symptoms  just  enumerated,  there 
are  others  which  prevail  more  or  less  in  almost  every 
case  ;  but  they  are,  on  the  whole,  less  constant  and 
more  diversified  ;  and  of  these  one  sometimes  predo- 


3^  THE  JVIIMOSIS  ACUTA. 

minates  so  much  over  the  rest,  as  to  engross  the  at- 
tention of  the  patient  and  sometimes  of  the  practi- 
tioner, too  exclusively.  The  secondary  affection  'is 
then  considered  as  idiopathic,  and  the  symptom  is 
apt  to  be  treated  as  the  disease.  It  is  therefore  of 
the  utmost  importance  to  present  the  reader  with  the 
following  distinct  enumeration  of  these  symptoms  : — 

1.  headach;  vertigo;  stupor;  etc. 

2.  COUGH  ;  VISCID  expectoration.  , 

3.  paroxysms    of    oppressive    DYSPN(EA. 

4.  palpitation  of  the  heart;  fluttering  ;  faintishness  ; 

irregularity  and  frequency  of  the  pulse. 

5.  FREqUENT   and    VIOLENT    HICCOUGH  ;    VOMITING    OF  FOOD. 

6.  SOME     CONVULSIVE    AND    SPASMODIC    AFFECTIONS. 

7.  PAIN    IN    THE    EPIGASTRIC,    OR    ONE    OR    BOTH    OF    THE    HY- 

FOGHONDRIAC,    OR    CHONDILIAC    REGIONS. 

8.  CONSTIPATION  ;    DIAHRHtEA  ;    TENESMUS. 

9.  H£MATEM£SIS  ;    MELiENA. 

10.  ICTERUS, 

11,  SEVERE    PAIN   OF    SOME    OF    THE    LIMBS. 

13.   SUDDEN   TUMEFACTION    OF  THE    INTEGUMENTS,  ESPBCIALLY 
OF    THE    FACE.* 

35.  The  diagnosis  in  these  cases  will  be  attempted 
in  the  section  appropriated  to  this  subject.  At  present 
it  is  of  importance  to  remark  that  in  most  instances, 
even  where  one  of  these  symptoms  is  particularly 
marked  and  severe,  several  concur,  and  arc  experi^ 
enced  in  a  mitigated  form,  affording  a  characteristic 
feature  of  this  disorder  and  a  principal  source  of  dis- 

»  Sec  Secfion  II.  and  the  Table  of  Contents. 


DESCRIPTION  WITH  CASES.  S^ 

crimination  ;  for  whilst  most  local  diseases  are  denoted 
by  being  simple  and  definite,  this  affection  is  distin- 
guislved  by  its  multiplicity,  and  by  apparently  con- 
joining many  or  all  disorders  in  one, — Ouch  ^en  ti 
tun  kakon  phainetai  all'  etin  ote  polla  e  kai  panta. 

36.  This  form  of  Mimosis  is  also  characterized, 
although  less  so  perhaps  than  the  more  chronic  and 
continued  forms  of  this  affection  to  be  described  hcre- 
after>  by  being  variable, — ^better  and  worse, — with 
this  and  that  prevailing  feeling  or  symptom, — even  du- 
ring a  general  recovery; — changes  chiefly  induced 
by  bodily  fatigue,  mental  agitation,  errors  in  diet,  or 
constipation. 

37.  It  is  also  to  be  remarked  that,  althougli  the 
usual  accession  of  this  affection  is  insidious,  as  stated 
§  S3,  yet  when  the  causes*  inducing  it  are  severe,  or 
the  patient  subject  or  predisposed  to  this  affection,  it 
may  appear  in  a  still  .more  acute  form  ;  and  in  this 
case  it  assumes,  in  some  instances,  even  the  character 
of  a  Febrile  disorder ;  and  in  others,  that  of  a  serious 
morbid  affection,  soon  depriving  the  patient  both  of 
strength  and  of  flesh  in  an  alarming  degree. 

38.  By  an  attention  to  the  circumstances  detail- 
ed §  0%  and  by  a  reference  to  the  general  symptoms 
of  the  Mimosis  Acuta,  ^^  g4i — 33,  the  different  se- 

•  See  Section  III. 


S6  THE  MIMOSIS  ACUTA. 

eoudary  affections  may  be  generally  distinguished 
and  identified,  in  their  connexion  with  the  primary 
disorder.  It  should,  however,  ever  be  borne  in  mind 
that  an  idiopathic  and  organic  affection  of  some  part 
may  co-exist  with  the  Mimosis  Acuta.  The  diagnosis 
is  then  often  very  difficult.  It  is  frequently  only  as- 
certained when  the  state  of  disorder  constituting  Mi- 
mosis, is  removed.  The  prognosis  should  therefore 
be  given  with  caution. — Anotlicr  circumstance  sug- 
gesting caution  in  the  prognosis,  is  the  possibility  of 
the  transition  of  the  state  of  disorder  into  that  of 
DiSEASf:,  which  is  not  unusual  in  those  parts  and 
organs  which  are,  at  first,  only  affected  in  a  second- 
ary and  functional  manner, 

39.  In  the  less  severe  form  of  the  Mimosis  Acuta, 
the  debility,  tremor,  loss  of  flesh,  and  tendency  to 
faintishncss  and  perspiration,  §  S4,  are  less  observed,^ 
although  perhaps  not  altogether  absent, 

40.  In  this  form  of  the  Mimosis  Acuta  the  coun- 
tenance is  rather  sallow,  and  its  surface  is  more  or 
less  affected  as  in  the  severer  form  described  above. 
The  tongue  and  the  internal  mouth  are  often  affected 
in  the  severer  degree  described  ^  S6.  The  patient  is 
incapable  of  pursuing  any  laborious  employment.  He 
is  prone  to  perspire  from  slight  exertion  or  agitation. 
He  perhaps  experiences  some  loss  of  flesh.  He  is  low 
spirited  and  listless.  The  appetite  is  sometimes  im- 
paired, but  sometimes  craving.     And  he  suffers  from 


/ 


DESCRIPTION,  WITH  CASES.  S/' 

the  symptoms  described  §§  30 — 33,  and  from  the 
complications  enumerated  §  34?,  only  in  a  milder  and 
more  protracted  form  than  the  subject  of  the  severer 
cases  of  Mimosis  Acuta. 

41.  Besides  the  symptoms  enumerated  §  34,  the 
less  severe  but  more  continued  form  of  the  Mimosis 
Acuta,  is  sometimes  attended  with  one  of  the  follow- 
ing affections  ;— 

1.  FURUNcuLi ;  paronychia;  hordeola. 

2.  ERYSIPELAS  ;  ERYTHEMA  NODOSUM  ',  URTICARIA  CHRO- 

NICA ;    LICHEN. 

3.  PURPURA. 

4.  ULCERATIONS    AND   PUSTULES    ON    THE    CONJUNCTIVA. 

5.  DECAY    OF    THE    TEETH;     A     MORBID     STATE     OF     THE 

GUMS  ;    CHRONIC    SORE    THROAT. 

6.  SOME    AFFECTIONS    RESEMBLING    SYPHILIS.* 

42.  Persons  who  have  long  laboured  under  a  state 
of  Mimosis  appear  liable  to  decline,  at  length,  into 
Phthisis  Pulmonalis,  or  to  become  the  subjects  of 
other  organic  disease,  and  especially  of  the  Liver. 


See  Section  IL  and  the  Table  of  Contenls. 


S8  THE  MIMOSIS  ACUTA 


43.  It  may  now  be  proper  to  confirm  the  dc»y 
cription  of  the  Mimosis  Acuta  just  given,  by  a  selec- 
tion from  the  cases  from  which  it  has  been  taken  :- — 

44.  Case  I.  The  first  case  of  the  Mimosis  Acuta 
which  I  was  enabled  to  distinguish,  was  that  of  Mr. 
M  aged  25. — He  had,  as  I  understood,  been  treated 
for  Fever,  principally  by  the  pulvis  antimonialis,  for 
several  weeks. — He  was,  on  my  first  visit,  affected 
with  tremor,  debility,  tendency  to  perspiration,  and 
had  suffered  a  considerable  loss  of  flesh.  The  tongue 
Avas  affected  with  large  papillae,  indented,  and  much 
loaded;  the  breath  was  extremely  fcetid.  The  pulse 
Avas  frequent.  He  cc^nplained  of  pain  in  the  left  hy- 
pochondre. — These  complaints  were  soon  removed  by 
a  course  of  gentle  purgatives. — This  patient  was  em- 
j)loyed  in  the  sedentary  occi^pation  of  the  lace-frame. 

45.  Case  IT.  The  second  case  occurred  soon  after 
the  former,  and  was  noted  rather  more  particularly. — 
Mr.  S,  aged  Sj,  had  been  indisposed  several  weeks 
when  I  first  saw  him,  and  had  left  Nottingham  for 
the  country  ;  he  had  taken  saline  powders  principally, 
and  1  therefore  judge  that  his  complaint  had  been 
deemed  i<erfr;  it  had  made  very  considerable  pro- 
gress in  inducing  a  loss  of  flesh  and  strength.  The 
countenance,  especially  the  lips  and  chin,  was  affected 
with  a  tremulous  movement  on  speaking;    there  was 


DESCRIPTION,  WITH  CASES.  39 

an  expression  of  great  debility;  theprolabium  of  each 
Jip  was  palish.  He  was  scarcely  able  to  walk  or  stand 
erect^  in  attempting  which  he  tottered  and  trembled  5 
and  there  was  a  manifestation  of  great  feebleness  in 
the  general  manner.  The  skin  was  moist  The 
tongue  was  affected  with  enlarged  papillae  much 
loaded,  and  indented  ;  the  mouth  in  general  was  very 
disagreeable,  and  the  breath  tainted  and  foetid.  The 
pulse  was  frequent,  and  easily  and  greatly  accelerated. 
He  w^s  extremely  nervous,  and  easily  agitated.  He 
had  no  appetite.  The  bowels  were  costive,  with 
scanty  and  offensive  stools.  The  yrine  deposited  a 
most  copious  sediment. — The  friends  of  this  patient 
now  suspected  an  attack  of  Consumption, — The  affec- 
tion yielded  very  soon  to  the  administration  of  purga- 
tive medicines. 

46.  Case  III.  J.  S.  aged  30.  He  had  been  ill 
during  three  months  before  his  application  to  me, 
having  been  affected  at  first  with  constipation  of  the 
bowels,  which  yielded  to  a  state  of  diarrhcea,  with 
discharges  of  hlood  by  stool.  He  had  suffered  much 
loss  of  flesh  and  strength.  I  made  the  following  short 
note  on  first  seeing  this  patient ; — the  countenance  is 
rather  pale,  with  a  little  appearance  of  oily  or  clammy 
perspiration  ;  the  tongue  is  much  loaded  ;  he  is  much 
thinner  than  when  in  health :  feeble ;  tremulous  oq 
holding  out  the  hand  ;  he  becomes  faint  when  stand- 
ing upright;  he  is  nervous  and  easily  flurried  and 
agitated ;  he  has  suffered  from  headach  and  vertigo  ; 


30  THE  MIMOSIS  ACUf  A. 

lie  has  experienced  much  sense  of  fluttering  in  the 
region  of  the  heart ;  he  has  no  cough,  and  has  not  had 
hiccough. — He  became  soon  better^  in  every  respect, 
from  taking  the  pil.  hydrag.  and  magnesia  with  rhu- 
barb and  pimento. 

47.  Case  IV.  Mrs.  F.  aged  S4.  She  was  married 
five  months  ago  and  supposes  herself  pregnant.  She 
began  to  be  indisposed  seven  weeks  ago,  becoming 
afiected  with  sickness,  load  and  wind  at  the  stomach, 
hiccough,  lowness,  weakness,  and  loss  of  flesh. — Tlie 
following  note  was  taken  on  visiting  this  patient : — 
The  countenance  is  rather  pale  and  the  eye-lids  dark. 
She  has  lost  much  flesh.  Complains  of  weakness. 
She  is  easily  hurried  by  surprise,  and  slie^then  com- 
l)lains  of  a  sense  of  fluttering  at  the  pit  of  the  stomach. 
There  is  no  sweating.  She  suffers  from  headach  some- 
times. She  is  sleepless  during  the  night.  She  sighs 
frequently.  There  is  no  cough.  Much  hiccough,  a 
sense  of  load  and  wind  at  the  stomach,  eructation, 
and  sometimes  sickness  and  vomiting.  The  appetite 
is  very  bad.  The  bowels  costive.  The  catamenia 
arc  suppressed  and  the  mammae  enlarged. — This  pa- 
tient proved  to  be  pregnant. — She  recovered  slowly 
And  gradually,  from  the  use  of  purgative  medicines. 

48.  The  two  following  cases  pVesent  the  appear- 
ances in  the  Mimoses  Acuta,  in  its  less  severe  form  : — 

49.  Case  V.  July  Sth,  1818.  Mr.  S.  F.  aged  ^3. 
He  had  worked  during  one  year  in  the  lace  frame, 


DESCRIPTION,  WITH  CASES.  31 

l^riucipally  during  the  night,  when  he  became  affect- 
ed with  the  following  complaint,  about  four  months 
ago.  He  first  experienced  an  unusual  degree  of 
'weakness,  which  incapacitated  him  for  his  employ- 
ment }  he  then  complained  of  a  propensity  to  sweating, 
on  any  slight  exertion  or  emotion,  with  pain  of  the 
Lead,  loss  of  appetite,  constif>s.tion,  &c.  At  first  too, 
3ie  lost  his  flesh  rather  rapidly,  to  the  amount^  as  be 
supposes,  of  about  14lb.  The  countenance  became 
palish  and  sallow,  and  he  was  told  tlvat  he  had  a 
Liver  Comjplaint,  The  general  weakness  increased, 
and  a  degree  of  trembling  was  observed  when  he  lifted 
Jhis  cup  of  tea  to  his  mouth,  and  when  he  attempted  to 
walk  or  underwent  any  fatigue. — At  present  the  pro- 
labifi  are  rather  pale,  the  face  near  the  nose  is  affected 
with  an  oily  perspiration,  the  eye-lids  are  dark,  and 
the  general  complexion  is  of  a  palish,  sallow  appear- 
ance. The  albuginea  is  perfectly  white.  The  tongue 
is  white,  loaded,  and  clammy.  He  perspires  more 
than  usual  on  any  exertion.  He  has  no  headach  or 
vertigo  now,  and  has  had  no  cough  at  any  time. 
There  is  a  sense  of  fluttering  about  the  heart  and 
stomach,  especially  on  lying  down.  He  says  that  he 
is  low  spirited,  and  does  not  like  to  be  long  alone  or 
still.  His  appetite  is  still  impaired  5  he  complains  of 
a  sense  of  load  at  the  stomach,  with  eructation,  but 
he  has  no  hiccough.  The  bowels  are  open.  The 
jirine  was  at  first  much  loaded,  but  it  is  less  so  now. 
Jle  complains  of  shifting  pains  about  the  limbs.— 
Tiiese  complaints  have  been  nearly  stationary  lately. 


3S  THE  MIMOSIS  ACUTA. 

the  progress  they  appeared  to  he  making  at  first  hav- 
ing been  arrested. — The  patient  became  gradually 
better,  after  the  date  of  this  report,  by  taking  opening 
medicines,  batliing,  and  using  gentle  exercise  with  a 
cliange  of  air. 

50.  Case  VI.  Mr.  E.  J.  aged  28,  a  tailor.  This 
patient  has  felt  indisposed  for  a  year  or  more,  from 
recurrent  pain  of  the  head,  and  in  the  left  Iiypochon- 
driac  region  ;  with  an  irregular  state  of  the  bowels,—?- 
constipation  alternating  with  diarrhoea, — -the  stool's 
being  extremely  foetid,  scanty  and  dark- coloured. — 
Five  weeks  ago  he  became  more  seriously  indisposed 
and  incapacitated  for  work,  from  faintishness,  weak- 
ness, tremor,  tendency  to  sweating,  looseness  of  th6 
bowels,  a  loaded  state  of  the  tongue,  mouth,  and 
breath,  and  dryness  of  the  throat,  but  without  any 
manifest  loss  of  flesh. — At  present  the  countenance 
appears  rather  bloated,  dark  in  complexion,  with  a 
clammy  oily  moisture.  The  tongue,  gums,  and  in- 
ternal mouth  are  considerably  aiffected,  and  there  is  a 
degree  of  salivation,  which  has  been  observed  for  a 
month  or  two.  The  skin  is  cool,  and  there  is  a  tend- 
ency to  perspiration  on  any  exertion  of  body  or  agi- 
tation of  mind.  He  complains  of  weakness,  trembling, 
and  faintishness  :  and  of  sweating  whenever  he  is  sur- 
prised or  hurried,  which  readily  happens.  liis  sleep 
is  sometimes  disturbed  by  dreams.  The  appetite  has 
always  been  tolerable.     The  bowels  have  generally 


DESCRIPTION,  WITH  CASES.  33 

been  lt)Ose,  especially  in  the  niglit,  and  the  stools 
scanty;  offensive,  and  dark-coloured. — The  following 
is  the  patient's  own  account  of  his  complaints  : — ^  I 
have  long  had  occasional  pain  m  the  head,  and  in  the 
left  side  under  the  ribs  ;  my  hands  tremble  very  much 
when  I  have  heen  at  work ;  I  feel  faint  and  w^eak :  1 
sweat  much  ;  I  have  suffered  much  from  purging  du- 
ring the  last  four  months,  having  sometimes  had  six 
or  seven  motions  in  the  course  of  a  night ;  I  suffer 
much  from  a  sour  and  disagreeable  taste  in  ray  mouth, 
and  experience  dryness  with  phlegm  in  my  throat,  and 
a  sensation  of  hairs  on  my  tongue.' — This  patient's 
complaints  w^ere  ascribed  to  a  too  assiduous  attention 
to  his  sedentary  business,  w  hich  he  w  as  induced  to 
pay  from  feeling  the  pressure  of  a  young  and  numerous 
fa.ivily. — He  is  already  much  better  from  employing, 
only  for  a  short  time,  mild  purgative  medicines,  gen- 
tle exercise,  daily  bathing  in  the  Trent,  and  a  light 
nutritious  diet;  but  the  cure  is  now  less  rapidly  pro- 
gressivc  than  at  first,  a  circunitetance  very  usual  in 
this  affection. 

51.  Case  VII.  This  case  i^  remarkable  for  the 
degree  of  tremor  by  which  it  was  so  long  attended. 
E.  W.  a  tailor,  aged  36.  August  3rd,  1819.  He  has 
been  indisposed  one  year.  During  the  heat  of  last 
summer,  he  became  affected  with  pain  of  the  head 
which  was  relieved  by  a  spontaneous  diarrhoea,  and 
he  lost  his  flesh  and  strength,  and  became  affected 
with  great  tremor  from  which  he  has  never  recovered. 


34  THE  MIMOSIS  ACUTA. 

He  remained  feeble,  tremulous,  and  thiu,  and  sub- 
ject to  vertigo,  fluttering  at  the  scrobiculus  cordis, 
nervousness,  impaired  appetite,  and  tendency  to  con- 
stipation,— when  1  iirst  saw  him  in  February.  The 
degree  of  tremor  was  very  remarkable ;  on  being 
asked  to  write  down  his  complaints,  he  gave  me  the 
following  list ; — <  weakness,  trembling,  being  easily 
overcome,  and  made  to  perspire,  and  frequently  fainty 
and  fluttered  ;' — the  tongue  was  clammy  and  slightly 
indented,  the  bowels  irregular — constipation  alter- 
nating with  diarrhoea.  Rhubarb,  sulphat  of  magnesia^ 
calcined  magnesia,  &c.  were  prescribed,  and  the  coun- 
try air  recommended.  Under  this  procedure  he  gain- 
ed flesh  and  strength,  and  his  general  health  improv- 
ed. He  has,  however,  again  experienced  some  of  the 
priding  symptoms  since  he  returne'd  to  his  sedenia- 
ry  occupation. 

5^.  Case  VIII.  This  case  exemplifies  the  extraor- 
dinary degree  of  nervousness  which  sometimes  attends 
this  morbid  afiection.  I  have  given  one  reppit  only, 
for  the  sak&of  brevity  ;  the  subsequent  ones  were  only 
repetitions  of  the  same  symptoms  w  ith  their  usual  va- 
riation,—Mi\  H.  T.  aged  2i.  June  25tli,  1819.  He 
states  that  he  had  been  weak  and  low  for  some  time, 
when  seven  w  eeks  ago,  after  reading  the  account  of 
the  assassination  of  Mr.  Percival,  he  was  taken  with 
great  alarm,  and  has  since  experienced  the  follow- 
ing complaints. — He  has  lost  his  colour,  flesh,  and 
strength.     The  countenance  is  palish,  and  inclined  to 


I 


DESCRIPTION,  WITH  CASES.  ^5 

sallowness  ;  the  prolabia  are  however  of  good  colour. 
He  thinks  he  has  lost  a  stone  of  flesh.  He  breaks  oat 
into  perspiration  on  the  slightest  exertion  ;  the  least 
thing  induces  alarm,  hurry,  trembling,  fluttering 
about  the  heart,  nervousness,  &c.  The  tongue  is 
rather  white  ;  the  breath  feet  id ;  the  mouth  clammy 
und  disagreeable.  There  are  headach,  heavy  pain  at 
the  occiput,  vertigo,  loss  of  memory,  fear  of  insanity, 
sleepiness  ;  oppression  about  the  chest,  with  sighing 
breathing  ;  the  pulse  is  nearly  natural ;  there  was  at 
first,  loss  of  appetite,  but  this  is  now  rather  removed 
from  taking  opening  medicine  ;  the  bowels  were  cos- 
tive ;  the  urine  is  different  at  different  times,  being 
liigh-qoloured  and  pale  alternately,  and  sometimes 
fcetid. 

53.  Having  thus  given  a  condensed  view  of  seve- 
ral cases  of  the  Mimosis  Acuta,  in  both  Jts  forms,  I 
shall  now  proceed  to  state  the  particulars  of  some 
other  cases  more  in  detail  :  — 

54.  Case  IX.  Mrs.  K.  aged  32.  She  was  af- 
fected by  a  complaint  similar  to  the  one  about  to  be 
described,  two  years  ago.  There  were  tremor,  loss  of 
flesh,  and  great  frequency  of  the  pulse.  The  affection 
was  deemed  incipient  Phthisis  by  an  eminent  practi- 
tioner. The  complaint  receded,  but  returned  in  Au- 
gust, 18 17.  The  first  symptoms  then  observed  were 
a  yellowness  and  darkness  of  complexion,  inducing 
some  apprehension  of  Jaundice  ;  loss  of  flesh  ;  weak- 


36  THE  MIMOSIS  ACUTA. 

ness  in  walking ;  a  tendency  to  stooping  in  walking 
or  sitting  ;  great  tremulousness  of  the  countenance  in 
speaking,  and  of  the  hand  when  held  out;  tendency 
lo  perspiration  both  during  the  night  and  day.  Tliere 
were  occasionally,  and  especially  at  first,  violent  head- 
achy and  at  other  times,  vertigo.  Twice  on  going  to 
bed,  there  was  viok^nt  palpitation  of  the  heart,  ren- 
dering the  erect  position  necessary,  and  attended  with 
coldness  of  the  feet.  The  pulse  varied  from  120  to 
130.  The  appetite  was  greater  than  natural.  The 
bowels  are  said  to  have  been  regular. — This  patient 
residinn:  at  a  considerable  distance  from  Notlin2;hara, 
a^id  tlie  nature  of  her  complaint  being  unknown  to 
me,  1  corresponded  with  Mr.  K,  and  in  order  to  as- 
certain whether  a  journey  to  Nottingham  were  really 
necessary,  I  begged  that  a  register  might  be  kept  of 
the  WEIGHT  of  the  patient,  from  time  to  time.  Of 
this  register  the  follovi:ing  is  a  copy  ;-— 

On   ^ivgust  the  ISth,  1817,    ih^   -weJ^ht   -ioas    106/*. 
On         -         -      25ih,         ....        106^/6. 

A  journey  having  been  taken  jit  this  time^ 

On  September  the  Ist^tlia -.vei^ht  teas         -      -    IQSlb, 
On         -         .       Sth,         -         -         .         .         105^^. 
On  October    -       6//i,         ....         106/6. 

fThe  patient  having  returned  home, 

On  ^'cn^ember  Hie  3rd,  the  Tseightivaa  -         lOcJJb. 

On       -       -     7th^       ....       lom. 

On         .         .     17  th,  ....  98^/5. 

On        .         .     26/A,  .         ,         .         .  96|/A. 

On  December  the  1st,  -         -         -         .  93i!l'. 

Oik        .        .      6/A,  .        .        ,        -  fJ2i/6. 


DESCRIPTION  WITH  CASES.  ^7 

At  this  period  it  was  judged  expedient  that  Mrs. 
K.  should  come  to  jSoUiugiiam. — The  countenance 
then  appeared  thin,  rather  sallow,  and  with  a  dark 
ring  round  the  eyes.  The  tongue  was  clean  and 
moist,  but  lobulated,  somewhat  in  the  manner  of  some 
parts  of  the  cerebellum.  There  was  considerable  tre- 
mor in  speaking  and  in  holding  out  the  hand.  There 
was  manifest  emaciation,  btill  some  headach  and 
vertigo.  The  pulse  was  about  130,  sometimes  even 
140.  Some  days  before  there  had  been  palpitation  of 
the  heart  on  going  to  bed.  No  cough.  No  shivering. 
The  appetite  was  great.  The  bowels  said  to  be  reg- 
ular.— Mrs.  K.  was  now  recommended  a  course  of 
purgative  medicines. — The  countenance  gradually  im- 
proved, both  in  flesh  and  colour ;  the  strength  return- 
ed ;  there  was  a  greater  capability  of  exertion ;  the 
flesh  was  restored  in  the  following  manner  :  — 

0«  December  the  15/A,  the  -weight  ivas  94lb. 
On        -     "   -      22d,        -         .       -    06ib. 

The  pulse  was  often  as  low  as  114  and  116,  but 
was  easily  accelerated.  At  this  period  Mrs.  K.  re- 
turned into  Lincolnshire.  During  the  week  before 
January  16,  1818,  she  had  gained  two  pounds.  The 
amendment  continued  progressive,  and  in  July  the 
weight  was  stationary  at  1061b.  The  pulse  was  nearly 
natural,  and  the  tremor  and  debility  had  disappeared. 
The  interval  had  been  occupied  in  travelling.  The 
use  of  the  purgative  medicines  had  been  continued, 
jaA  a  little  ale  and  a^  nutritive  diet  had  been  allowed. 


38  THE  MIMOSIS  ACUTA. 

— The  affection  had  been  previously  deemed  "a  JJis- 
ease  of  the  Hearty  and  had  been  treated  with  the  di- 
gitalis. 

56.  This  case  was  thus  so  far  modified  in  its  differ- 
ent periods  as  to  assume  the  characters  of  three  differ- 
ent diseases,  Phthisis,  Icterus,  and  Disease  of  the 
Heart.  It  therefore  affords  an  interesting  illustration 
of  the  general  character  of  this  affection,  and  of  the 
propriety  of  the  denomination  adopted  for  it. 

57.  Case  X.  Mr.  D.  S.  aged  53.  He  was  in- 
disposed nearly  in  the  manner  about  to  be  described, 
in  May,  18 17.  The  complaint  had  come  on  slowly 
and  gradually.  It  was  removed  by  pills  composed  of 
thp  pil.  hydrag.  and  rhubarb. — The  affection  returned, 
and  made  at  first  a  slow,  and  afterwards  a  more  rapid 
progress.  In  November  last,  he  became  incapable  of 
supporting  the  fatigue  of  an  easy  occupation.  About 
Christmas  his  complaint  made  serious  advances,  and  I 
saw  him  again  on  January  the  5th.  On  this  day  he 
was  affected  with  an  emaciated  countenance,  a  tre- 
mulous state  of  the  lips,  a  darkness  of  complexion,  and 
a  clammy  perspiration  on  the  cheeks  near  the  nose. 
^^he  tongue  was  loaded,  especially  at  the  back  part, 
with  bright  red  papillse  at  the  point,  and  redness  of 
its  sides,  and  it  exhaled  a  halituous  moisture  ;  the 
breath  Avas  extremely  foetid.  He  was  extremelf^  fee- 
Ule,  almost  incapable  of  walking,  and  affected  with 
great  and  constant  tremor,  and  with  a  sense  of  weari- 


DESCRIPTION,  WITH  CASES.      ^  ^^ 

liess.  There  had  been  great  loss  of  flesh  :  III  Sep- 
tember he  weighed  9st.  7lb.  and  on  this  day  only  8st, 
lllb.  There  was  great  perspiration  daring  the  night, 
but  no  febrile  heat.  The  finger  nails  had  assumed  ii 
pale  lilac  hue.  There  was  little  headachy  but  great  ver- 
tigo, and  faintishness  when  upright.  Kestless  and 
sleepless  nights.  No  cough.  Frequently  rapid,  vio- 
lent, and|irregular  paljntaiion  of  the  heart,  often  with- 
out external  exciting  cause.  The  pulse  was  frequent 
and  extremely  irregular.  There  has  been  mucli  hic- 
cough ;  at  a  previous  period  this  symptom  had  been 
violent,  painful,  and  almost  constant,  during  fifteen 
days.  Twice  there  had  been  vomiting.  The  appetite 
was  much  impaired.  The  bowels  were  early  laxa- 
tive ;  but  the  stools  were  soanty,  dark  coloured,  and. 
foetid — To  this  date,  January  31,  1818,  the  symptoms 
gradually  declined  : — the  countenance  is  improved^ 
the  strength  much  restored,  the  tremor  diminished, 
and  he  has  this  day  walked  a  distance  of  three  miles 
to  Nottingha  m ;  the  appetite  is  better,  and  the  hic- 
cough has  ceased.  The  stools  are  more  natural  in 
colour,  but  still  offensive.  The  following  is  the  re- 
gister of  this  patient's  weight  to  this  period  : — 


In  September^ 

9s;. 

7Jb. 

On  January  the  5th, 

8s/. 

Wlb. 

On        -      -      12rA,      - 

-        Sst. 

6lb. 

On        -      -      19//,,       - 

8st 

eib. 

On        .     -      26th,      - 

Sst. 

9lb. 

So  that  by  the  use  of  purgative  medicines,  the   pro- 
gress of  the  emaciation  has  been  successively  dimi- 


40 


THE  MIMOSIS  ACUTA. 


nished  and  arrested,  and  a  degree  of  flesh  has  heeri 
restored. 

February  23.  It  has  been  stated  that  on  the  day 
of  the  last  report,  the  patient  walked  three  miles  ;  the 
fatigue  of  this  exertion  was  too  great  for  his  strength 
although  much  restored  ;  and  from  tliis  cause,  or  from 
partaking  greedily  of  celery,  or  from  having  neglect- 
ed his  purgatives,  he  experienced  a  most  serious  re- 
lapse.— The  ensuing  week  he  lost  31b.  in  weight.  He 
became  affected  with  a  constant  and  violent  liiccoughy 
which  continued  night  and  day.  There  was  a  com- 
plete interruption  to  sleep  and  repose.  The  debility^ 
weariness,  and  tremor  returned.  The  head  was  af- 
fected with  vertigo.  The  pulse  was  extremely  irre- 
gular.— The  purgatives  were  repeated ;  pills,  con- 
taining opium  and  hyosciamus  were  prescribed  ;  and 
afterwards  an  enema  with  eighty  drops  of  the  tinctura 
opii. — During  the  second  week,  he  again  regained 
^Ib,  of  flesh  ;  the  hiccough  ceased ;  rest  was  procured ; 
and  he  again  became  renewed  in  strength. — This  im- 
provement still  continued,  and  on 


Fehmary  the  16th,  Jie  roeighed  8«<.     6/^. 


. 

23d, 

Sat. 

SW. 

March  tlie 

2d, 

8st. 

m. 

.         .         . 

9lh, 

Su. 

m. 

. 

16th, 

88t. 

9lb. 

. 

23d,        . 

.   8s/. 

12  1.21b 

. 

30ih, 

98t. 

Olb. 

June  the'    . 

30th, 

.  9st. 

Alb. 

DESCRII*TI0N,  WITH  CASES.  41 

It  is  remarkable  however  that  this  patient's  im- 
provement in  Hesh  was  not  attended  with  a  propor- 
tionate  amendment  in  strength  and  general  health. 
He  still  remained  feeble  and  tremulous  ;  he  complain- 
ed extremely  of  jpam,  lameness,  and  wearineas  in  the 
loins^  arms,  and  legs  ;  he  had  once  more  a  severe  at- 
tack of  hiccough,  which  was  much  relieved  by  taking 
white  wine  vinegar  in  doses  of  a  teaspoonful.--He 
continued  his  opening  medicine,  which  consisted  prin- 
cipally of  rhubarb,  and  he  has  all  along  ttaken  ale. 
— The  following  is  the  patient's  own  list  of  his  com- 
plaints during  the  course  of  his  indisposition : — 
^^  trembling,  weakness,  weariness,  faintishness,  loss 
of  flesh,  cold  and  greasy  perspirations,  sleepless  nights 
pain  of  the  head,  dizziness,  palpitation  of  the  heart, 
hiccough,  disagreeable  breath,  loss  of  appetite,  a  con- 
tinued lax,  weakness  and  bearing-down  of  the  bow- 
els, much  pain  and  lameness  of  the  limbs.'' 

July  27.     This  patient  has  lost  2lb.  o^Jlesh  during 
the  last  month ; 

072  Juft/  the  iSlhf  he  weighed        .         ,       9.?/.     5/J. 
On         .       27th,  ....       9s.'.     2lb. 

Oa  March  WM,  1819,  still  .         .       9i7.     21', 

but  he  states  that  he  has  gained  strength  notwith- 
standing, and  that  the  muscles  appear  to  be  firmer  on 
his  limbs.  The  tremor  is  very  much  less.  His  lame- 
ness, principally  in  the  shoulders,  is  much  diminished 
and  he  has  now  no  pain.     The  tongue  is  still  loaded- 


#^  THE  MIMOSrS  ACUTA. 

The  nights  still  restless.  The  bowels  less  loose.  The' 
appetite  improved.  There  has  been  no  hiccough 
lately.  There  is  still  some  degree  of  the  sense  of  flut- 
tering about  the  heart,  and  the  pulse  is  84,  and  not 
quite  regular.- "He  considers  himself  better,  and  in- 
tends to  resume  his  usual  occupation  in  a  few  days, 
Eut  he  is  evidently  in  a  state  of  health  altogether 
jxrecarioust 

August  31,  My  patient  has  continued  to  improve 
in  appearance,  strength,  flesh,  and  general  health, 
and  there  is  now  a  hope  of  permanency  in  this  amend- 
ment. He  has  continued  to  take  rhubarb  principally, 
with  a  little  ale,  and  a  nutritious  diet ;  he  is  enjoined 
daily  exercise,  bathing  during  the  warm  season,  and 
sponging  when  it  becomes  cold. 

58.  Case  XI.  The  last  case  which  I  shall  detail 
in  this  place,  will  afford  another  instance  of  the  ex- 
treme diversity  in  the  history  of  this  affection. ---Miss 
M.  A.  aged  19,  employed  at  the  tambour.  Two 
years  and  a  half  ago  she  became  affected  with  loss  of 
flesh,  great  weakness,  faintishness,  palpitation,  flut- 
tering about  the  heart,  vertigo,  headach,  and  general 
nervousness  ;  she  was  at  the  same  time  easily  startled 
and.  affected  with  agitation  and  trembling.  Four 
years  ago  she  was  affected  with  Melcerta,  aiid  again 
two  years  and  a  half  ago,  together  with  the  sympr^ 
tome  just  detailed. --She  seemed  to  recover  from  these 
complaints  and  waiS  in  better  health  during  the  sum- 


DESCRIPTION  WITH  CASES.  43 

mcr  of  1817 .  In  October  she  again  became  affected 
with  the  symptoms  of  the  Mimosis  Acuta,  and  she 
had  again  melaena  with  the  other  symptoms.  She 
"took  the  pil.  hydrag.  with  rhubarb;  and  has  never 
since  had  any  discharge  of  blood.  She  recovered 
rapidly  during  several  weeks.  Her  complaint  then 
became  stationary,  and  afterwards  worse.  She  took 
to  bed,  and  continued  almost  constantly  in  bed  for 
twelve  weeks.  She  continued  her  pills,  and  united 
the  most  nourishing  diet  she  could  obtain,  with  a 
little  ale.  A  month  ago  she  rose  from  her  bed,  and 
has  since  gradually  improved  in  strength  and  some- 
what in  flesh,-"At  present  the  countenance  is  pale  ; 
she  is  very  feeble  ;  she  however  trembles  less ;  she 
has  some  appetite  ;  the  bowels  are  kept  open  by  pills 
of  rhubarb  ;  the  tongue  is  whitish  ^he  seems  to  be 
recovering,  and  complains  most  of  vertigo  and  pain 
of  the  head,  of  fluttering,  of  occasional  palpitation,  of 
faintishness,  weakness,  &c»— Feb.  22,  1819.  This  pa- 
tient has  gradually  and  imperceptibly  recovered  ;  but 
still  remains  feeble,  tremulous,  at  times,  aiwl  pale. 
The  tongue  is  whitish,  the  bowels  costive ;  she  com- 
plains of  pain  of  the  head  and  back ;  two  weeks  ago 
she  again  parted  with  three-fourths  of  a  teacupful  of 
blood,  and  again  ten  days  and  a  week  ago,  with  pain  in 
the  bowels;  without  haemorrhoids.- -April  ISth.  She 
is  still  more  recovered. ---May  3.  She  now  looks  very 
well,  but  complains  of  headach. 


41:  THE  MIMOSIS  ACUTA. 

aO.  The  extreme  variety  in  the  history,  the  form^ 
the  course  and  the  duration,  of  the  Mimosis  Acuta, 
will  be  sutTiciently  evident  from  the  cases  thus  detailed. 
The  accession  of  this  affection  is  usually  slow  and  in- 
sidious, as  before  stated  ;  but  it  is  now  and  then  deve- 
loped, and  apparently  occasioned,  by  the  occurrence 
of  some  other  indisposition,  or  of  an  accident. 

.  60.  It  is  a  question  of  great  interest,  how  far  the 
original  affection,  the  complications,  and  the  changes, 
in  this  multifoim  complaint,  are  to  be  viewed  in  the 
light  of  causes  and  of  effects.  But  I  dare  not  enter 
into  this  discussion  at  present.  I  shall  only  observe 
that  this  connexion  seems  often  to  be  distinctly  ob- 
servable ;  and  that  the  functional  derangements  have 
appeared,  in  some  instances,  to  have  undergone  the 
changes  denoted  by  the  term  metastasis,  the  affection 
of  one  organ  having  been  nearly  forgotten  by  the  pa- 
tient, whilst  the  derangement  of  another  has  en- 
grossed his  attention;  in  one  case  the  patient  had 
labourejl  from  symptoms  of  organic  disease  of  the 
jieart  for  several  years ;  this  was  at  length  almost  for- 
gotten, and  his  chief  complaint  w  as  an  alarming  de- 
gree-of  vertigo. 

61.  The  amendment  from  the  employment  of  the 
course  of  gentle  tonic  purgatives  to  be  noticed  more 
particularly  hereafter,  is  often  rapid,  and  in  cases  of 
short  duration,  and  especially  in  youth,  the  cure  i$ 
scM)n  effected  ;  but  in  cases  of  longer  duration,  when 


DESCRIPTION,  WITH  CASES.  45 

the  constitution  lias  suffered  materially^  and  when  the 
age  of  the  patient  is  more  advanced^  the  progress  to- 
wards amendment  is  slow,  and  apt  to  he  interrupted, 
— especially  by  errors  in  diet,  imprudent  exertions, 
and  accidental  agitations  of  mind.  The  severer  form 
of  the  Mimosis  Acuta  is  rapid  in  its  course  ;  the  less 
severe  form  may  continue,  or  be  protracted,  for  seve- 
ral years  ;  the  two  forms  may  pass  into  each  other 
respectively  ;  and  each  may  be  variously  complicated 
at  different  periods. 

6S.  Some  of  the  accessory  affections  too,  may  as- 
sume the  serious  and  alarming  character  of  disease, 
especially  those  of  the  head,  heart,  lungs,  liver,  sto- 
mach, or  bowels. 

63.  The  chance  of  cure  is  in  an  inverse  ratio  to 
the  age  of  the  patient,  to  the  previous  duration  of  the 
complaint,  and  to  its  effect  in  undermining  the  gene- 
ral system,  or  in  inducing  local  organic  derangement. 

*? 

64.  In  conclusion  of  the  History  of  the  Mimesis 
Acuta,  I  must  regret  my  ignorance  of  the  morbid 
anatomy  of  this  affection.  This  subject  Avill  not_, 
however,  be  neglected  if  opportunities  for  dissection 
should  be  offered  to  me  hereafter. 

Q^^I  have  noticed  the  Weight  of  patients  affected  with  the  Mimosis  AcrxA. 
I  intentl  hereafter  to  pursue  tliis  subject  in  relation  toCano?«ic  Disorders  and 
Diseases  in  general.  The  investigation  would  appear,  a  priori,  to  lead  to  some 
useful  information  relative  to  the  Diagnosis  and  Prognosis.  The  result  of  this 
Uljestigation  will  be  given  in  another  work,— the  Principles  of  Diagnosis. 


4^  THE  DIAGNOSIS. 


SECTIOX  II.    THE  DIAGNOSIS. 


I.  THE  DIAGNOSIS  OF  THE  GENERAL 
AFFECTION. 

65.  THE  Mimesis  Acuta,  in  its  severer  but  sim- 
pler form,  has,  I  think,  been  generally  mistaken  for 
Fever  ;  in  its  less  severe  form  it  is  necessary  to  dis- 
tinguish this  affection  from  ohscure  and  Insidious 
Organic  Disease  ;  and  in  its  complications,  the 
Mimosis  Acuta  must  be  carefully  discriminated  from 
an  original  and  local  disease  of  the  i>art  symptomati- 
cally  affected. 

66.  From  every  kind  of  Idiopathic  Fever,  with 
which  the  Mimosis  Acuta  agrees  in  apparently  affect- 
ing the  whole  system  or  many  organs  at  once,  this 
affection  may  be  distinguished  by  an  attention  to  the 
History  of  the  case,  and  to  the  particular  con- 
currence OF  symptoms. 

67.  From  the  Febris  Brevis*  the  Mimosis  Acuta 
differs  entirely  in  its  History  ;  but  it  is  probable  that 
the  nature  of  these  two  affections  is  similar.  The  for- 
mer is  quick  or  sudden  in  its  accession,  and  of  short 
duration  5  the  latter  is  insidious  and  gradual  in  its 

•  See  the  trcatfee  on  Diagnosis,  Part  II.  §  I. 


THE  MIMOSIS  ACUTA.  47 

jformation,  and  of  more  or  less  considerable  continu- 
ance. The  mistake,  however,  may  be  made,  if  refer- 
ence be  not  had  to  this  circumstance  5  for  the  general 
aspect  of  the  patient,  the  countenance,  the  tongue,  the. 
surface,  and  some  of  the  symptoms,  are  very  similar  in 
both  affections. 

68.  From  the  Febris  Acuta*  the  Mimosis  Acnta 
is  at  once  distinguished  by  the  absence  of  the  suffusion 
and  tumidity  of  the  countenance,  and  of  the  heat, 
tumidity,  softness,  injection,  and  dryness  of  the  gene- 
ral surface,  so  characteristic  of  that  kind  of  Fever. 
In  the  Febris  Acuta  there  is  more  urgency  and  acute- 
ness  of  complaint ;  the  patient  is  obliged  to  beialce 
himself  to  bed;  the  head  is  more,  or  more  constantly 
affected  ;  and  the  breathing  more  anxious  and  hurried, 
whilst  there  is  an  absence  of  the  symptoms  detailed^ 
§  24.  The  History  of  the  two  affections  is  also  very 
dissimilar,  the  Febris  Acuta  generally  following  some 
manifest  exciting  cause,  and  being  formed  quickly^ 
attd  thus  affording  a  striking  contrast  with  the  insidi- 
ous formation  of  the  Mimosis  Acuta. 

69.  From  the  Febris  Lentaj  the  Mimosis  Acuta^ 
is  distinguished  by  an  attention  to  the  state  of  the 
countenance,  of  the  general  surface,  and  of  the  tongue  ^ 
to  the  peculiar  concurrence  of  symptoms  ;  and  to  the 
History  of  the  affection. — In  the  Febris  Lenta  thfr 
countenance  is  often  partially  flushed,  the  surface  be- 

•  See  the  ti'eatise  on  Diagnosis,  Part  II.  §  2.        f  Ibid.  §  4'. 


48  THE  DIAGNOSIS. 

comes  dry,  with  a  burning  heat,  and  the  skin  hat'sh 
and  exfoliating,  a  state  sufficiently  contrasted  with 
the  cool  and  clammy  condition  of  tlie  countenance  and 
general  surfiice,  and  the  tendency  to  perspiration,  ob- 
served in  the  Mimosis  Acuta ;  in  the  Febris  Lenta, 
the  tongue  is  at  first  whitish,  and  afterwards  clean, 
perhaps  morbidly  clean,  red,  smooth,  and  dry,  whilst 
the  breath  is  little  tainted,  a  sufficient  contrast  to  the 
state  of  the  tongue  in  the  Mimosis  Acuta,  §  S8.  In  the 
Febris  Lenta  the  patient  suffers  perhaps  from  vertigo, 
but  there  is  little  faintishness  or  fluttering,  and,  in 
general,  no  tendency  to  perspiration  ;  the  patient  is 
rather  torpid  than  nervouii,  and  less  alive  to  those  cir- 
cumstances which  are  apt  to  induce  so  much  hurry 
and  agitation  in  the  Mimosis  Acuta,  and  the  Fever  is 
altogether  a  less  multiform  and  multiplex  aU'ection. 
The  patient  affected  Avith  the  Febris  Lenta  perhaps 
sits  up  for  a  time  ;  then  becomes  gradually  worse  and 
obliged  to  remain  in  bed  and  in  the  horizontal  posi- 
tion ;  he  is  in  this  manner  for  a  longer  or  shorter  pe- 
riod  in  an  inactive  state,  and  at  length  as  gradually 
recovers  or  sinks  ;  in  the  Mimosis  Acuta  the  patient 
generally  remains  all  along  out  of  bed,  or  at  least 
much  longer  than  in  the  former  case  ;  and  the  affec- 
tion changes  and  varies  more  in  its  severity  and  in 
its  form,  both  in  its  beginning  and  decline. 

70.    The  Febris  Gravis*   is  distinguished  from 
the  Mimosis  Acuta  by  Uie  peculiar  aspect  and  appear- 

*  See  tht  trcatisg  on  DrAG:^osis,  Fart  II.  ^§6,  Tr 


THE  DUGNOSIS.  49 

ance  of  the  patient;  which  are  generally  recognized 
by  those  who  have  noticed  them  with  attention:  — 
there  is  a  look  of  great  weakness  and  oppression,  and 
the  patient  appears  almost  incapable  of  supporting  or 
retaining  the  erect  position,  or  of  undergoing  the 
slightest  fatigue.  The  Febris  Gravis  is  early  attended 
with  dulness,  pain,  or  vertigo  about  the  head,  and 
with  peculiar  aching  pains  of  the  limbs  and  loins. 
There  are  sometimes  burning  heat  and  a  degree  of 
harshness,  sometimes  a  cool  moisture  of  the  general 
surface.  The  tongue  is  at  first  loaded  but  generally 
soon  becomes  parched,  dry,  and  cracked.  The  bowels 
are  torpid. — The  Febris  Gravis  is  generally  jprmed  ra- 
pidly, and  the  patient  usually  betakes  himself  early 
to  bed, — These  circumstances  sufficiently  distinguish 
the  Febris  Gravis  from  the  Mimosis  Acuta. 

71.  I  shall  now  proceed  to  draw  the  Diagnosis 
between  the  less  severe  form  of  the  Mimosis  Acuta 
and  Insidious  Organic  Disease.  In  the  first  place 
the  latter  affection  presents  a  complete  contrast  with 
the  character  of  the  Mimosis  in  general,  stated  §  ^  j^ 
it  is  distinguished  by  its  definite  form,  and  by  a  regu- 
lar, slow,  progressive,  and  almost  unvaried  course, 
during  which  the  patient  becomes  gradually  affected 
with  paleness,  debility,  and  emaciation,  with  compa- 
ratively little  tremor — The  countenance  becomes  pale 
and  thin,  with  long  and  deep  wrinkles,  but  generally 
semains  free  from  tremor,   except  in  phthisis  pulma- 

♦  See  also  the  treatise  on  Diagitosis,  Part  II,  §  1«^ 
G 


50  THE  MIMOSIS  ACUTA. 

nalis,  and  it  is  peculiarly  expressive  of  disease.  The 
muscular  strength  becomes  gradually  much  impaired ; 
but  this  loss  of  streugth  differs  from  that  observed  in 
tiic  Mimosis  Acuta,  in  being  less  attended  with  the 
rcitfarkablc  degree  of  tremor  observed  in  the  latter 
affection.  The  general  surface  is  without  the  peculi- 
arity observed  in  the  Mimosis  Acuta,  §  27.  There  is 
generally  an  absence  of  the  headach  or  vertigo,  the 
faintishness,  the  sense  of  fluttering,  the  nervousness, 
the  tendency  to  cold  perspiration,  and  of  the  complex- 
ity, observed  in  the  Mimosis  Acuta,  §^  S4 — 84.  The 
tongue,  internal  mouth,  and  breath  are  at  first  com- 
paratively little  affected,  but  afterwards  frequently 
become  covered  with  aphthae.  Tliere  are  chilliness, 
spontaneous  chills,  and  flushes,  and  early- morning 
perspirations. — At  length  the  emaciation  becomes  ex- 
treme ;  the  ankles  become  cedematous  ;  and  anasarca, 
or  ascites  may  supervene. 

72.  The  reader  will  bear  in  mind,  at  the  same 
time,  the  possibility  of  the  transition  of  the  Mimosis 
from  the  state  of  Disorder  to  that  of  Organic  Disease, 
already  adverted  to,  §.  38. 

• 

73.  Before  I  quit  the  subject  of  Insidious  Organic 
Diseases,  I  shall  digress  somewhat  from  the  proper 
object  of  this  work,  in  order  to  call  the  reader's  at- 
tention, in  a  particular  manner,  to  the  characteristics 
of  a  disease  of  this  nature,  the  Diagnosis  of  which  is 
not  always,  I  think,  established  in  practice ;— namely, 


THE  DIAGNOSIS.  oi 

the  Strumous  Affection  of  the  Mesentery  in 
Adults  J — a  subject  which  appears  to  me  to  have  been, 
in  some  degree,  neglected  by  practical  writers. 

74.  This  disease  is  particularly  characterized  by 
its  very  slow  and  insidious  accession  and  progress  ;  by 
an  unusual  sensibility  to  cold  5  by  a  tendency  to  cold- 
ness and  lividity  in  the  nose  and  fingers ;  by  the 
absence  of  any  affection  of  the  head,  or  of  flutteriug 
or  palpitation  of  the  heart ;  by  the  continued  good 
appetite  and  the  copious,  light-coloured,  and  foetid 
stools  ;  perhaps  by  a  fixed  tenderness,  and  perceptible 
tumor,  in  some  part  of  the  abdomen,  which  is  not 
tumid  generally  ; — the  tumor  in  the  abdomen  is  not, 
however,  always  perceptible,  nor  are  the  alvine  evac- 
uations at  all  times  of  the  pale  and  fcetid  kind  above 
described.  There  are  a  peculiar  appearance  of  the 
countenance,  a  peculiar  mode  of  walking,  and  a  pe- 
culiar attitude  and  manner  in  general, — the  whole 
denoting  great  disease,  and  a  serious  state  of  emaci- 
ation and  debility. — This  affection  is  also  character- 
ized by  the  circumstances  detailed  §  71?  contrasted 
with  §^  2,  2%  and  by  resisting  the  usual  remedies  of 
the  Mimosis  Acuta. 

75.  I  think  the  Strumous  Affection  of  the  Mesen- 
tery in  Adults  by  no  means  a  rare  affection.  I  have, 
within  the  last  year  and  a  half,  seen  it  in  the  persons 
whose  cases  have  been  detailed,*  in  a  young  woman 

*  First  Edition,  pp.  35 — il 


52  THE  MIMOSIS  ACUTA. 

aged  31,  in  a  young  man  aged  22,  in  a  soldier  aged 
30,  and  in  a  lady  aged  50.  Some  of  the  symptoms 
of  Phthisis  Pulmonalis  are  often  superadded  to  those 
of  Diseased  Mesentery  ;  and  this  disease  is  often  con- 
joined, in  a  greater  or  less  degree,  with  Phthisis. — I 
intend  to  republish  the  cases  which  were  inserted  in 
the  first  edition  of  this  work,  together  with  some 
others  which  I  have  witnessed  more  recently,  in  and- 
ther  place  ;  they  will  be  contrasted  with  some  cases  of 
Insidious  Inflammation  of  the  Peritonaeum. 

76.  There  is  an  Effect  «f  Drunkenness  which 
resembles  in  many  symptoms  the  severer  form  of  the 
Mimosis  Acuta  ;  and  as  it  admits  less  readily  of  cure, 
it  is  important  to  distinguish  the  two  aflPections. — In 
this  Efi'ect  of  Drunkenness  there  are  great  weakness, 
tremor,  and  emaciation.  The  case  is  characterized 
by  a  peculiar  state  of  countenance  ; — there  is  emacia- 
tion ;  the  expression  is  much  lost ;  the  eyes  assume 
a  peculiar  streaked,  yellow  colour.  The  tongue  and 
mouth  are  loaded,  and  perhaps  dry,  and  there  is  a 
peculiar  fcBtor  of  the  breath.  The  manner  of  the  pa- 
tient is  dull,  and  often  slovenly.  There  is  a  consider- 
able loss  of  flesh.  There  is  often  a  total  loss  of  appe- 
tite. The  bowels  are  generally  loose.  There  are,  I 
think,  fewer  of  the  complications  noticed  §  34,  than  in 
the  Mimosis  Acuta.  But  there  is  more  frequently 
organic  disease. — Particular  inquiry  should  therefore 
be  made  into  the  Habits  of  a  patient  affected  with 
symptoms  of  the  Mimosis  Acuta. 


THE  DIAGNOSIS.  53 

77.  This  affection  may  be  exemplified  by  the  fol^ 
lowing  Case  : — Mr.  S.  C.  aged  27-  He  had  dmnk 
excessively  of  ale  for  12  monshs,  when  he  became 
affected  six  months  ago  with  lowness,  weakness,  loss 
of  flesh,  fluttering  at  the  heart,  loss  of  appetite,  with 
little  affection  of  the  digestion  or  bowels.  He  had 
also  an  early  hoarseness  of  voice.  These  symptoms 
have  continued  and  the  loss  of  strength  and  flesh  has 
progressively  increased  to  the  present  time, — he  for- 
merly weighed  lOst.  12lbs,  and  now  8st.  13lbs.  The 
countenance  is  very  thin ;  the  tongue  loaded  at  the 
back  part  5  the  voice  hoarse ;  pulse  88  ;  not  much 
tremor  or  nervousness. — He  has  gradually  gained 
strength  and  flesh  since  he  began  a  course  of  tonic 
purgatives,  and  relinquished  his  pernicious  habit  of 
drinking. 


Mf  THE  MIMOSIS  ACUTA. 


II.    THE  COMPLICATIONS  AND  THEIR 
DIAGNOSIS. 

78.  It  may  be  remarked  that  the  complications 
Avith  the  Mimosis  Acuta  in  its  severe  form  are,  in 
general,  continued,  until  removed  by  remedies ;  the 
complications  with  the  less  severe  form  of  Mimosis 
Acuta,  are  recurrent  in  paroxysms,  until  the  tendency 
ta  the  original  disorder  is  overcome.  The  former 
cases  sooner  take  on  organic  derangement  than  the 
latter,  and  are  more  immediately  serious. 

1.   Of  Affections  of  the  Head. 

5^&.''^The  affections  of  the  head  which  occur  in  con- 
junction with  the  Mimosis  Acuta,  sometimes  assume 
an  apoplectic  and  sometimes  an  epileptic  character ; 
sometimes  there  is  troublesome  pain,  or  vertigo,  or 
some  affection  of  vision  or  of  the  hearing. 

80.  The  Mimosis  Acuta  complicated  with  an  Af- 
fection of  the  Head,  is  distinguished  from  an  Idio- 
pathic Disease  of  the  Head,  by  uniting  the  char- 
acters noticed  §%  1,  S,  24,  et  seqq.  with  symptoms  of 
affection  of  the  cncephalon,  whilst  the  latter  affection 
is  denoted  by  its  simple,  definite,  and  regular  charac- 
ter, and  the  absence  of  those  affections. 

81.  There  are  two  occurrences  which  ought  ever 
to  be  present  to  the  mind  of  the  practitioner: — the 


THE  DIAGNOSIS.  55 

first  is  the  tendency  to  the  transition  of  a  secondary^ 
into  Organic  Affection,  which  is  particularly  observ- 
ed with  regard  to  the  Head ; — the  second,  the  possi- 
bility of  the  CO- existence  of  the  Mimosis  Acuta,  and 
of  Idiopathic  Disease  of  the  Head. 

83.  The  transition  of  the  secondary  affection  of 
the  head  in  the  Mimosis  Acuta  into  an  Organic  Dis- 
ease, or  the  co-existence  of  the  latter  affection  with  the 
former,  is  to  be  apprehended  on  the  occurrence  of  any 
of  the  following  symptoms  in  a  serious  degree  and 
continued  form  : — A  sense  of  flushing  or  fulness  about 
the  head  ;  acute  pain  of  the  head  ;  unusual  heaviness^ 
dull  headach,  or  vertigo ;  drowsiness,  stupor,  disturbed 
sleep,  delirium,  incubus,  stertor ;  forgetfulness,  timi- 
dity, confusion  of  mind,  change  of  affections,  tenden- 
cy to  laughter,  or  tears ;  affection  of  the  senses,  as 
temporary  loss  of  sight,  flashes  of  light,  double  vision, 
singing  or  loud  noises  in  the  ears,  intolerance  of  light, 
or  sound, — tenderness  of  the  scalp.  Many  of  these 
symptoms,  however,  occur  in  the  Mimosis  Acuta.  It 
is  only  when  they  exist  in  an  eminent  degree  that 
they  denote  danger.  But  it  is  best  to  take  an  early 
alarm.  The  danger  of  organic  affection  of  the  head  is 
less  equivocal  on  the  occurrence  of  an  unusual  distor-. 
tion,  or  an  unmeaning  expression,  of  the  countenance ; 
of  a  defect  in  articulation  ;  of  a  temporary  numbness 
or  torpor,  or  of  transient  and  partial  weakness  of  any 
of  the  limbs  ;  especially  if  one  side  of  the  body  alone 
be  affected.     The  occurrence  of  stupor,  convulsion. 


M  THE  MIMOSIS  ACUTA. 

paralysis,  or  relaxation  of  the  spiacters,  leaves  little 
to  doubt  respecting  the  existence  of  internal  tlisease 
of  the  head. 


83.  The  following  melancholy  instance  of  the  com- 
bination of  the  Mimosis  Acuta  with  an  apoplectic  Af^ 
fection  of  the  Head;  is  particularly 'instructive  :— 

84.  (Iase  Xll.  Mr.  G.  aged  33,  had  experienced 
symptoms  of  Mimosis,  with  a  loaded  state  of  the  tongue, 
internal  mouthy  and  breath,  for  several  months  ;  he 
had  been  observed  to  complain  much  of  the  head,  fre- 
quently applying  the  hand  to  the  forehead,  or  laying 
the  head  on  a  table,  and  statins:  that  he  suffered  from 
severe  pain.  On  visiting  him  he  seemed  to  be  affect- 
ed with  symptoms  of  the  febris  brevis,  but  the  His- 
tory agreed  more  with  that  of  the  Mimosis: — the 
countenance  was  moistened  with  a  clammy  or  oily 
perspiration,  the  tongue  and  breath  loaded  ;  he  com- 
plained of  dulness  about  the  head,  but  made  light 
of  the  affection.  His  complaints  increased  notwith- 
standing the  use  of  very  active  purgatives  ;  on  minute 
inquiry  he  had  noticed  a  defect  in  vision, — the  lines 
he  w  as  reading  sometimes  disappearing  as  if  covered 
by  the  finger ;  he  complained  of  tenderness  of  the 
scalp,  of  sensibility  to  the  light,  and  he  requested  that 
his  room  might  be  darkened.  Afterwards  he  was 
seized  with  stupor,  the  pupils  dilated,  and  the  pulse 
became  slow — about  55  in  the  ^pinute.  By  bleeding 
blistering,  purging,  &c.  these  symptoms  disappeared, 


THE  DIAGNOSIS.  4>7 

and  recognition  retarned.  But  in  two  days  after- 
wards^ restlessness,  delirium,  with  picking  of  the 
bed-clothes,  followed  by  stupor,  with  ruttliug  in  the 
breathing  apparently  from  phlegm  in  the  fauces, 
came  on  during  the  night.  The  pulse  was  strong  and 
full  at  six  in  the  morning.  But  nothing  was  done  for 
the  patient.  The  pulse  became  gradually  feeble,  the 
countenance  pale  and  sunk,  the  respiration  labour- 
ed, with  still  greater  ruttling.  About  half  after  ten, 
some  remedies  were  resorted  to,  but  too  late,  and  in 
vain.  The  left  side  of  the  face,  and  the  extremities 
of  tjie  left  side  became  paralytic,  and  he  expired  about 
twenty-four  hours  after  th.e  second  attack  of  stupor. 
Au  examination  of  the  encephalon  was  refused. 

85.  The  following  cases  assumed  in  some  degree, 
the  epileptic  form. 

86.  Case  XIIE.  Mr.  E.  aged  50,  has  been  sub- 
ject to  derangement  of  the  digestive  function  for 
many  years, — always  increased  by  anxiety  or  fatigue, 
— and  requiring  a  frequent  recourse  to  rhubarb  and 
peppermint  water.  About  six  years  ago  he  began  to 
be  frequently  obliged  to  leave  the  desk  of  the  count- 
ing house,  from  experiencing  confusion  of  the  head. 
Five  years  ago,  after  having  suffered  during  several 
days  from  sickness,  lassitude,  and  vertigo,  Mr.  K.  was 
taken  suddenly  in  church  with  severe  vertigo,  fainti- 
ness,  general  perspiration,  sickness  and  some  vomit- 
ing :---he  asked  for  a  glass  of  water,  rejected  it  from 

H 


53  THE  MIMOSrS  ACUTA. 

the  stomacli,  and  was  then  relieved,  but  remained 
feeble  for  the  rest  of  the  day.  From  this  time  Mr. 
E.  experienced,  with  some  of  the  symptoms  just  de- 
tailed, occasional  attacks  of  singing  in  the  ears  and 
glimmering  of  the  sight,  but  had  no  severe  return  of 
tlje  affection  until  October,  1819,  when  he  suddenly 
fell  down  ia  the  yard,  as  if  he  had  been  shot, — again, 
in  the  winter,  when  sitting  near  the  fire,  the  feet  start- 
ing upwards  and  the  head  falling  on  the  arm  of  the 
chair,---and  once  more  in  May  last.  These  attacks 
were  anticipated  from  vertigo  and  lassitude,  and  were 
followed  by  sickness  and  perspiration,  and  for  some 
days,  by  an  unpleasant  stupor.  On  the  whole,  the 
affection  has  increased  in  ih^  frequency  of  its  returns 
during  the  last  two  years.  Mr.  E.  mentions  an  over- 
whelming feeling  on  awaking  which  compels  him  to 
get  up  and  not  to  venture  ta  sleep  any  more.  Fa- 
tigue, anxiety,  and  attention  of  the  mind  have  ap- 
peared to  re-induce  the  feelings  of  this  distressing 
complaint. — Leeches,  cupping,  and  venaisection  have 
lieen  employed,  but  only  with  temporary  relief.  Re- 
lief of  a  more  decided  and  permanent  kind  has  resulted 
from  a  course  of  active  purgative  medicine,  by  which 
much  dark  and  foetid  faeces  have  been  evacuated.  The 
tongue  and  complexion  were  as  usually  observed  in 
protracted  cases  of  Mimosis. 

87.  Case  XIV.  The  following  account  is  given 
in  the  patient's  own  words.  ^  The  first  time  I  expe- 
rienced this  malady  was  about  the  age  of  15.      It 


THE  DIAGNOSIS.  51) 

came  on  during  the  time  I  was  endeavouring  to  recol- 
lect my  usual  repetition  which  I  had  learnt  but  imper- 
fectly ;  I  had  been  standing  some  time,  and  at  length 
sank  on  the  floor,  but  recovered  in  a  lew  minutes. --- 
These  attacks  were  repeated  at  remote  intervals  until  I 
was  about  2i  or  22,  when  they  became  more  frequent. 
— At  this  time  I  w  as  engaged  without  intermission  in 
the  professional  duties  of  an  attorney,  and  was  natural- 
ly of  a  sedentery  disposition,  even  in  my  amusements. 
— I  was  about  this  time  and  previous  to  it,  subject  to 
an  almost  constant  pain  in  my  head  and  eyes,  and  occa- 
sionally to  lassitude  and  w^ant  of  energy. — I  took  but 
little  exercise,  lived  very  moderately,  but  ate  heartily. 
About  this  time  1  applied  to  Dr.  S.  I  adhered  to  his 
medicine  for  some  time  and  found  myself  much  bene- 
fited by  it. — I  have  since  that  time  been  attacked 
more  rarely,  and  during  the  time  I  pursued  the  reme- 
dies prescribed  by  you,  I  do  not  recollect  having  any 
return  of  the  complaints.  My  general  health  has 
been  much  improved  by  the  medicine  which  I  have 
taken  whenever  I  found  the  state  of  my  bowels  re- 
<]uired  it. — I  had  flattered  myself  tliat  1  should  not  be 
again  subject  to  these  attacks,  but  on  Wednesday  last 
I  experienced  another  instance  of  them.  1  had  been 
spending  about  a  week  in  the  country,  and  living  ra- 
ther more  generously  than  usual,  viz.  by  taking  ham 
or  meat  with  my  breakfast,  and  four  or  five  glasses  of 
ivine  after  dinner,  with  meat  suppers  &c. — On  Wed- 
nesday afternoon  I  had  been  standing  a  considerable 
ilme  exposed  to  a  cold  wind,  taking  sketches  of  the 


60  THE  MIMOSIS  ACUTA. 

cliurch,  and  felt  much  chilled  by  it. — In  the  evening 
"we  had  a  party  of  friends  and  I  sang  to  them  for  an 
hour  or  two  until  I   was  rather  fatigued. — About  11 
o^clock  at  night,  after  a  supper  of  fruit  pie,  the  attack 
came  on  in  the  usual  way,  by  an  involuntary  train  of 
ideas  presenting  themselves  to  my  mind,  which  pro- 
duced a  sickening^  effect  upon  me,  accompanied  at  the 
same  time  by  a  sort  of  fascination  which  led  me  al- 
most irresistibly  to  pursue  the  train  of  ideas,  whieli 
at  the  same  time  I  knew  would  occasion  me  to  faint, 
— ^I  say  almost  irresistibly,  because  I  have  sometimes 
checked  this  train,  and  by  rousing  myself,  prevented 
the  actual  faiuting  from  taking  place. — I  never  can 
completely  recall  the  train  of  ideas,  and  on  my  en- 
deavouring to  do  so,  I  feel  a  tendency  to  a  repeti- 
tion of  the  attack. — My  first  sensation  on  recovering 
sensibility  is  an  anxious  wish  to  pursue  the  dream, 
through  curiosity  to  see  the  event  of  it:  this  is  suc- 
ceeded- instantly  by  a  consciousness  of  my  situation 
and  an  anxiety  to  convince  my  friends  that  I  have 
quite  recovered  from  the  effects  of  the  attack.     I  feel 
a  wish  for  a  little  cold  water  and  my  face  is  covered 
by  a  cold  perspiration  ;  an  inclination  to  lie  down 
and  sleep  succeeds  and  in  a  few  minutes  I  am  quite 
restored. — Previously  to  the  attack  on  Wednesday  I 
felt  a  drowsiness  and  an  unusual  propensity  to  gape 
and  stretch  my  limbs  several  times. — On  my  recovery 
I  haf!  for  several  minutes  a  singing  in  the  back  of  my 
head,  like  the  noise  of  a  boiling  teakettle,  or  rather 
like  the  gradual  escape  of  fixed  air  from  a  bottle  when 


THE  DIAGNOSIS.  •  6 1 

the  cork  has  been  gently  loosened.---!  went  to  bed 
soon  afterwards  and  took  one  of  your  powders  and 
some  peppermint  water.  I  had  a  good  deal  of  unea- 
siness at  my  stomach  and  bowels  and  a  dislike  to  the 
usual  pressure  of  my  clothes  upon  them,  which  I 
attributed  to  flatulency.  My  feet  w  ere  very  cold  and  I 
Avas  very  drowsy. — The  medicine  operated  in  the 
morning  and  I  was  tolerably  well,  but  my  bowels 
have  not  yet  recovered  their  healthy  state. — I  have 
no  doubt  that  these  attacks  proceed  from  a  disordered 
state  of  my  stomach  as  they  are  generally  preceded 
by  costi^veness  and  lieadach.— June  3rd,  1820.' 

88.  Case  XV.  Mr.  W.  of  S.  aged  32.  This  young 
man  had  been,  for  some  time,  affected  with  confused 
pain  of  the  head,  vertigo,  &c.  One  day  he  was  taken 
suddenly,  fell  down  on  the  ground,  and  lay  in  a  state 
of  insensibility  for  some  time.  He  recovered,  but 
remains  subject  to  pain,  confusion  of  the  head,  verti- 
go, and  tendency  to  fall  down.  He  has  become  weak, 
nervous,  dispirited,  inert,  and  incapable  of  business. 
The  tongue  is  swollen,  loaded,  indented,  and  pasty, 
with  deep  folds  on  its  surface.  The  breath  exceed- 
ingly foetid.  The  countenance  has  a  diffused  appear- 
ance of  oiliness  and  gentle  flushing.  The  stomach 
and  bowels  are  much  disordered. — In  this  case  it  was 
dubious,  at  first,  whether  the  affection  arose  merely 
from  disorder  of  the  digestive  organs,  or  was  an  idio- 
pathic disease  of  the  head.  The  state  of  the  tongue^ 
breath,  digestive  organs,  mind,  &c.   seemed  to  indi- 


6»  •   THE  MIMOSIS  ACUTA. 

cate  a  symptomatic  affection  of  the  Head,  and  such 
the  History  seems  to  have  proved  it ;  for  the  latter 
symptoms  have  increased  materially  since  the  first 
time  I  saw  this  patient,  and  the  affection  has  assumed 
the  form  of  hypochondriasis. 

89.  The  following  Cases  illustrate  some  other 
affections  of  the  head  which  arise  from  a  state  of 
Mimosis. 

90.  Case  XVI.  Mrs.  M.  October  5,  1818.  On 
being  called  at  5  p.  m.  to  this  patient  I  found  her 
affected  with  insensibility  and  delirium  ;  pain  about 
the  umbilicus ;  hurry  and  rapidity  of  breathing  and 
a  feeling  of  want  of  breath  with  fluttering  ;  the  pulse 
was  130  ;  the  countenance  rather  pale  and  cool ;  she 
appeared  to  the  byestanders  to  be  faint ;  the  tongue 
rather  dry.  The  appearance  of  this  affection  was 
alarming ;  more  than  once  she  was  supposed  to  be 
expiring.  Five  grains  of  calomel  were  given  ;  a 
suppository  of  inspissated  molasses  was  introduced 
into  the  rectum.  They  were  long  in  operating  but 
at  length  produced  complete  relief. 

91.  Case  XVIL  C.  H.  aged  21.  He  complains  of 
severe  recurrent  pain  of  the  head  especially  of  the 
forehead,  with  great  noise  in  the  head.  The  tongue 
is  Very  loaded,  white,  and  indented.  The  bowels  are 
costive.     He  is  subject  to  these  complaints  and  is  a 


THE  DIAGNOSIS.  6^ 

frainework-knitter. — He  was  relieved  by  taking  two 
emetics  and  a  course  of  purgative  medicines. 

9S.  Case  XVIII.  Mr.  B.  aged  40.  June  8, 
1819.  He  is  subject  to  disorder  of  the  stomach.  A 
few  days  ago^  on  taking  cold,  this  disorder  was,  as 
usual,  aggravated,  and  he  was  aifected  with  severe 
pain  of  the  head  and  of  the  right  side  over  the  false 
ribs.  The  skin  was  moist,  and  clammy,  and  the 
tongue  extremely  loaded.  All  these  complaints  were 
removed  by  emetic  and  purgative  medicines  in  the' 
course  of  five  days,  and  he  is  now  free  from  acute 
complaint.  There  was  a  little  eruption  of  herpes  on 
the  lip. 

93.  In  one  gentleman  there  was  a  state  of  mind 
approaching  to  mental  derangement ;  in  a  lady  there 
was  an  attack  of  affection  of  the  head  with  4^  loss  of 
memory, — apparently  the  effects  of  a  state  of  Mimosis. 

94.  There  are  few  diseases  which  it  is  more  impor- 
tant and  more  difficult  to  recognize  early,  than  a  state 
of  Idiopathic  Inflammation  or  Organic  Disease  of  the 
Brain.*  The  Diagnosis  is  partly  negative.  For  the 
first  question  is.  Is  there  a  state  of  Fever,  of  Mimosis^ 
or  of  other  Disorder,  which  may  account  for  the  symp- 
toms of  cerebral  affection  ?      If  not,  there  is  greater 

*  See  Sir  G.  Blane's  paper,  in  the  Trans,  of  a  Soc.  for  the  Imp.  of  Med.  and 
Surg:.  Knowledge,  V.  2.  p.  giO;  Abernetliy,  V.  1.  pp.  202,  106;  Bateman's  Re- 
ports; passim ;  &c. 


64  THE  JNllMOSIS  ACUTA. 

apprehension  of  Idiopathic  Disease  of  the  Head,  in 
which  there  is  usually  an  ahsence  of  the  symptoms  oi' 
Idiopathic,  as  distinguished  from  Symptomatic  Fe- 
ver,* and  of  the  symptoms  of  Mimosis  ; — except  in 
the  cAses  of  complication. 


2.   Of  Jffeciions  of  the  Chest. 

.  93.  The  affections  of  the  chest  which  occur  ia 
consequence  of  a  state  of  Mimosis,  are,  principally* 
oppressive  dyspnoea  resembling  Asthma,  and  coui^h 
ivith  expectoration  resembling  Phthisis  Pulmonalis. 

96.  The  complication  of  the  Mimosis  Acuta,  with 
Paroxysms  of  Oppressive  Dyspnoea,  resembles  Asth- 
ma in  a  very  high  degree.  And  it  is  not  improbable 
that  xV|^hma  properly  so  called,  frequently,  if  not 
generally,  originates  in  a  complication  of  this  nature^ 
but  is  afterwards  continued,  or  repeated,  either  from 
a  degree  of  disorganization  induced  in  the  heart  or 
lungs,  from  the  influence  of  the  external  causes  of 
Asthma,  or  from  the  causes  of  Mimosis.  The  follow- 
ing cases  sufficiently  exemplify  the  complication  al- 
luded to  : — 

♦ 

97.  Case  XIX.  D.  M.  aged  SO,  a  tailor.  Au- 
gust 30,  1813.     He  has  complained  of  pain  and  other 

*  See  tho  treatise  on  Diagnosis,  Part  II,  §§  1,2,  4,  6,  7,  contfastec*  with  §>  ^■', 
5,  S  ;  and  Midi  §§  107,  108. 


/ 


THE  DIAGNOSIS.  65 

affection  of  the  chest  for  eight  or  tea  days  ;  but  he 
has  been  affected,  for  a  much  longer  period,   with 
vomiting,  pyrosis,  a  loaded  state  of  the  breath,  mouth, 
and  tongue,  constipation  of  the  bowels,  &c.     Three 
days  ago  he  was  bled,  from  the  idea  that  the  affec- 
tion was  a  case  of  pneumonia. — ^^I  was   called  to  him 
last  night : — The   breath   was  extremely   foetid,  the 
tongue  loaded,  the  bowels  constipated      He  was   af- 
fected with  a  paroxysm  of  urgent  dyspnoea,  complain- 
ed of  want  of  air,  and  said  he  was  dying;  the  dys- 
pnoea had  begun  an  hour  before,  and  had  become 
gradually  more  and  more  urgent ;  there  was  great  anx- 
iety; the  rrfftpiration  was  very  rapid,  and   seemed  a 
literal  gasp  for  breath.     He  had  also  a  cough,  attend- 
ed with  a  dull,  hollow,  peculiar  sound,  and  with  a 
copious,  frothy,  mucous  expectoration.      The   pulse 
was  about  100,  without  sharpness.      He  was  some- 
what relieved  by  taking  a  few  drops   of  aether,  and 
effectually  by  the  operation  of  a  purgative  of  calomel 
and  jalap. 

98.  Case  XX.  The  Rev.  Mr.  A.  aged  34.  He 
has  long  been  subject  to  a  state  of  Mimosis  Acuta  in 
its  less  severe  and  more  continued  form,  marked  by 
a  variable  degree  of  sallowness  of  the  complexion, 
loaded  tongue,  foetid  breath,  and  foulness  of  the 
mouth  in  general,  without  any  observable  loss  of  flesh, 
He  is  easily  hurried  by  surprise,  and  fluttered  ;  his 
complaints  are  then  aggravated,  and  accompanied  by 
nervousness  and  tremor.      The  same  effects  are  in- 


66  THE  MIMOSIS  ACUTA. 

(luced  hj  any  uuasual  mental  or.bodilj  exertion.— 
This  gentleman  is  subject,  at  tliese  times,  to  a  heavy 
and  dull,  or  to  a  more  acute  pain  of  the  occiput,  for 
which  cupping  has  been  deemed  necessary.  The  pain 
has  sometimes  been  relieved  by  the  horizontal  posture, 
and  sometimes  it  has  been  excited  by  an  empty  state 
of  the  stomach. ---In  other  attacks  the  pain  af  the  occi- 
put has  been  absent,  and  the  patient  has  been  affected 
with  dyspnoea,  attended  with  restlessness,  a  sense  of 
want  of  air,  a  necessity  for  being  fanned,  &c.  The 
paroxysm  has  generally  taken  place  about  1  a.  m. 
It  has  been  relieved  by  coffee.  It  has  usually  suc- 
ceeded to  an  increase  of  the  state  of  diiorder  consti- 
tuting Mimosis,  and  lias  been  obviated  by  correcting 
that  state.  It  has  recurred  at  distant  intervals  for 
several  years.  Formerly  the  dyspnoBa  was  attended 
M'ith  cough,  but  not  lately.  A  degree  of  oppression 
has  generally  been  experienced  during  the  day  suc- 
ceeding the  paroxysm,* 

99.  The  complication  of  the  Mimosis  Acuta  with 
Cough  and  Expectoration  is  still  more  common,  espe- 
cially in  protracted  cases  of  this  affection,  both  in  its 
severer  and  less  severe  forms.  This  complication  re- 
quires to  be  accurately  and  early  distinguished  from 
Phthisis  Pulmonalis,  or  to  be  accurately  traced 
into  a  similar  state  of  affection  of  the  general  system 
and  of  the  pulmonary  organs. 

*  See  further  the  treatise  on  Diagsosis^  Part  II,  pp.  206— to  209,  for  the  Diag- 
Bosties  of  Asthma. 


THE  DIAGNOSIS.  67 

100,  The  discrimination  is  again  to  be  begun 
hy  contrasting  the  ciiaraetcr  of  the  Mimosis  Acuta^ 
given  §§  2,  24,  et  seqq.  with  the  general  character  of 
Phthisis  Pulmonalis,  Avhich  is  very  dissimilar,  and 
almost  opposite  to  that  of  the  former  affection.  Phthi- 
sis Pulmonalis  is  simple  and  definite,  in  its  character  ; 
in  general  little  varied,  but  rather  continually  pro- 
gressive, in  its  course  ; — although  this  observation 
has  some  exceptions;  it  is  comparatively  free  from 
the  tremor,  fluttering,  susceptibility  to  hurry,  and 
general  nervousness,  observed  in  the  Mimosis  Acuta, 
§  24i ;  there  is  an  early  loss  of  flesh,  a  symptom  which 
ranks  amongst  the  first  which  arrest  attention ;  thero 
is  also  an  early  weakness,  but  this  is  different  from 
the  weakness  attending  the  Mimosis  Acuta,  being 
less  attended  by  tremor,  faintishness,  kc.  and  the  de- 
gree of  remaining  muscular  strength  is  even  rcmarka-. 
hie  in  the  latter  stage  of  Phthisis  Pulmonalis.* 

101.  The  countenance  in  Phthisis  Pulmonalis  early 
assumes  a  peculiar  and  delicate  paleness,  but  is  liable 
to  occasional,  or  spontaneous,  gentle  blushes.  Tliere 
is  often  an  early  movement  of  the  nostrils,  induced  by 
the  alternate  act  of  respiration,  affording  one  of  the 
earliest  diagnostic  signs  of  Phthisis.  The  hands  and 
general  surface  are  pale  and  delicate,  the  roots  of  the 
nails  frequently  rather  livid.     And  there  is  a  charac- 

*  For  the  Diagnostics  of  Plithisis  Pulmonalis  from  other  diseases  which  reseioe 
hie  it,  sec  the  late  m  ork  of  M.  Bayie,  Armstrong  on  Scarlet  Fever,  &c.  RcH's 
Surgical  Reports,  Vol.  1,  pp.  18,  21  ;  and  the  treatise  ou  Uxagxosis,  Part  II,  pp. 
109-.172,  1S9— 196. 


68  THE  MIMOSIS  ACUTA. 

Icristlc,  irregular,  alternation  of  chilliness,  fcverisfej 
41CSS,  and  perspiration.  There  is  an  obvious  labour 
in  respiration,  which  is  aggravated  on  going  up  stairs 
or  using  active  exertion ;  a  full  inspiration,  however, 
docs  not  always  occasion  inconvenience.  The  cough 
is  slight  and  tickling  at  first,  perhaps  without  vio- 
lence, and  is  less  early  attended  with  expectoration. 
The  pulse  is  permanently  frequent, 

10;3.  The  complication  of  cough  and  expectoration 
may  take  place  in  either  the  more  or  the  less  severe 
form  of  the  Mimosis  Acuta,  but  I  think  the  latter  case 
is  the  more  frequent. — In  the  severer  form  of  Mimosis 
Acuta  there  is  sometimes  an  evident  labour  in  breath- 
ing which  induces  a  movement  and  contraction  of  the 
nostrils,  and  there  is  a  degree  of  cough  with  the  expec- 
toration of  a  little  viscid  mucus. — In  the  less  severe 
form  of  this  affection  there  is  often,  for  a  considerable 
period,  a  copious  expectoration  of  transparent,  frothy, 
and  viscid,  and,  at  length,  of  opaque,  and  tinged  mu- 
cus. There  is  a  cough,  hard-sounding  at  first,  and 
occurring  in  fits  ;  afterwards  easier  and  less  in  fits  as 
the  expectoration  assumes  more  of  the  puriform  ap- 
pearance 5  and  again  difficult  and  in  painful  fits  as  the 
strength  of  the  patient  declines.  l*he  pulse  is  at  first 
little  accelerated ;  the  respiration  little  affected,  and 
the  nostrils  unmoved  ;  but  a  degree  of  movement  of 
the  nostrils,  of  labour  in  the  respiration,  and  of  fre- 
quency of  the  pulse,  is  observed  as  the  expectoration 
becomes  puriform,  and  streaked  with  blood,  and  as 


1 


THE  DIAGNOSIS.  )  69. 

disease  of  structure  is  induced  in  the  luugs.  The 
usual  symptoms  of  the  less  severe  form  of  tlie  Mimosis 
Acuta  are  superadded ; — the  skin  is  usually  is  already 
described,  but  sometimes  harsh  and  dry  ;  tlie  tongue 
is  sometimes  furred  and  black  at  the  back  part ;  and 
emaciation  takes  place  in  a  degree  commojisurate  with 
the  diseased  affection  of  the  lungs.  The  History  of 
the  case  is  peculiar, — the  affection  is  perhaps  cured 
by  proper  remedies,  or  becomes  stationary  and  miti- 
gated for  a  time,  perhaps  an  apparent  or  decided 
amendment  occurs  even  during  several  weeks,  and 
again  the  disease  proceeds, — so  that  the  physician  is 
alternately  elated  with  hopes  and  depressed  with 
fears, — circumstances  scarcely  observed  in  Phthisis 
Pulmonalis. 

103.  Case  XXI.  The  following  case  presents  an 
eminent  example  of  this  last  remark  relative  to  the 
course  of  the  complication  of  the  Mimosis  Acuta  with 
cough  and  expectoration,  when  the  affection  termin- 
ates fatally.  Mr.  N.  aged  39,  had  long  been  affected 
with  a  loaded  state  of  the  tongue,  swelling  of  the  gums, 
fcetor  of  the  breath  and  other  symptoms  of  the  Mimosis 
Acuta,  when  he  became  seized  with  symptoms  of  ai 
inflammatory  affection  of  the  chest,  which  were  re- 
moved by  bleeding,  and  blisters,  conjoined  with  purga- 
tive medicines.  He  seemed  to  get  better  of  the  imme- 
diate inflammatory  complaint  of  the  chest,  but  Ihe 
looked -for  restoration  of  iK^alth  and  strength  did  not 
ensue,  but  seemed  delayed  week  after  week,  without, 


76  THE  MIMOSIS  ACUTA. 

however,  my  retrograde  change.     He  recovered,  in- 
deed, a  little,  and  was  removed  to  a  short  distance  into 
the  country.     Here  a  manifest  amendment  hi  point  of 
strength  occurred  and  continued   during  two  or  three 
weeks.     But  this  amendment  did  not  proceed.    He  be- 
came stationary  once  more,  and  continued  in  a  dubious 
way  for  a  week  or  two  longer.     He  then  appeared  dis- 
tinctly to  lose  strength,  and  for  the  first  time  since  his 
recovery  was  looked  for,  there  was  a  sensible  loss  of 
iMkt  ^-Thus  five  weeks  transpired  from  the  abatement 
of  the  inflammatory  symptoms  to  the  period  of  the  pa- 
tient^s  going  into  the  country,  and  seven  weeks  more 
passed  between  hopes  and  fears  during  his  stay  from 
^Nottingham. — Durmgthe  course  of  this  complaint  the 
countenance  was    affected  with  an   oily  perspiration 
and  a  sallow  or  swarthy  complexion,  with  paleness  of 
the  prolabia.     The  mouth,  tongue  and  breath   were 
foul  and  loaded.     The  hands  and  nails  pale.    There 
was  a  most  remarkable  degree  of  tremor,  which  seem- 
ed  particularly    to   impede   the    voluntary   motions. 
I' here  was  at  first  scarcely  any  dyspnoea  or  movement 
cf  the  uostrils  ;  but  both  these  symptoms  were  observ- 
el  as  the  affection  of  the  lungs  was  supposed  to  pass 
into  organic  derangement.     There  was  at  iirst  a  hard 
coigh,  with  rather  viscid,   mucous  expectoration,  in. 
cieased  when  the  stomach  was  empty ;  afterwards  the 
expectoration  was  greater  in    quantity,  more  viscid 
and  opaque,  and  considerably  tinged  with  blood     The 
pulse  very  frequent.     The  bowels  were  kept  open  by 
medicine.     Tlie  appetite  was  tolerably  good. — The 


THE  DIAGNOSIS, 


7-1 


patient  survived  nearly  three  months  afier  this  report, 
the  affection  of  the  lungs  becoming  inorfr  and  more 
coalirmed,  the  flesh  being  completely  lost,  and  the 
strength  exhausted.  The  cough  was  jometimes  less 
severe;  the  expectoration  variable  in  quantity,  but 
free  from  the  tinge  of  blood  ;  the  pulse  less  frequent ; 
the  bowels  sometimes  affected  with  diarrhoea. — An 
examination  of  the  chest  was  refused. 

104.  Case  XXIL  In  another  case  there  were  conr 
siderable  loss  of  flesh  and  strength,  a  frequent  pulse, 
much  cough  with  copious,  mucous  expectoration,  and 
a  loaded  state  of  the  tongue  and  breath;  with  som© 
other  symptoms  of  the  Mimosis  Acuta.  The  affection 
yielded  very  favourably  to  the  operatioQ  of  mild  pur- 
gative  medicines  conjoined  with  small  doses  of  opium. 

105.  Case  XXIU.  In  a  third  case  there  were  all 
the  symptoms  of  the  severer  form  of  the  Mimosis 
Acuta,  together  with  a  slight  cough,  expectoration  of 
phlegm,  and  a  manifest  difficulty  in  respiration,  with 
movement  of  the  nostrils.  The  affection  yielded  most 
favourably,  and  the  healthy  strength,  and  flesh  return-^ 
ed,  by  the  use  of  purgative  medicines,  with  a  nutri- 
tious diet,  gentle  exercise,  and  the  country  air.* 


*  See  Abernetby,  V.  l-  p.  207;  Dr.  W.  Philip,  Med.  Cixir.  Trans.  V.  7.  pp. 
499,  &«. 


^%  THE  MIMOSIS  ACUTA. 


3.  Of  Jffections  of  the  Heart. 

106.  The  Sections  of  the  heart  which  occur  in 
consequence  of  the  Mimosis  Acuta,  arc  fluttering, 
jpalpitatioriy  irregilar  action^  and  syncope  more  or 
less  perfect. 

107.  Fluttering  and  Palpitation  of  the  Heart,  are 
amongst  the  most  frequent  symptoms  of  the  Mimo- 
sis Acuta  ;  it  is,  therefore,  scarcely  necessary,  especial- 
ly after  the  detail  of  Cases  IX  and  X,'  to  o5er  any 
exemplification  of  this  complication.  I  shall,  how- 
ever, make  a  few  observations  which  may  conduce  to 
the  establishment  of  a  correct  Diagnosis. — In  the  se- 
verer case  of  Mimosis  Acuta,  it  will  he  necessary  to 
wait,  and  to  watch  the  effect  of  the  remedies  in  re- 
moving this  disorder ;  the  palpitation  of  the  heart,  if 
a  consequence  and  effect  merely,  will  be  mitigated 
or  removed  with  the  original  affection.—  In  the  less 
severe  form  of  this  complaint,  the  discrimination  must 
he  principally  founded  on  a  cautious  observation  of 
the  effect  of  bodily  exercise  on  the  action  of  the  heart 
when  the  symptom  of  palpitation  is  otherwise  abisent, 
and  when  the  patient  is  least  indisposed, — and  on  the 
continued  History  of  the  complaint.  In  Disease  of 
THE  Heart  the  patient  often  emphatically  observes, 
^  I  should  be  well  if  I  vegetated  only ;  it  is  bodily  ex- 
ertion and  mental  agitation,  which  renew  and  recall 
the  sense  of  mv  dreadful  disease.'      In  the  roraplica- 


THE  DIAGNOSIS.  ^3 

fion  of  Mimosis  with  palpitation,  the  patient,  if  not 
prevented  by  weakness,  can,  at  the  time  when  the 
liurried  movement  of  the  heart  is  absent,  run  pretty 
rapidly,  or  walk  up  stairs,  without  suffering  more 
than  is  usual ;  and  periods  occur  when  he  has  passed 
several  days,  weeks,  or  months,  perhaps,  without  ex- 
periencing the  palpitation.  In  a  disease  of  the  heart, 
these  circumstances  are  not,  I  think,  observed  ;  the 
uneasy  sensations  which  accompany  this  disease,  if 
absent  at  times,  are  always  excited  on  any  corporeal 
exertion  ;  and,  as  I  have  elsewhere  observed,  disease 
of  this  organ  is  in  general  highly  characterized,  and 
distinguished  from  certain  symptomatic  disorders  of 
its  functions,  by  the  permanency,  of  the  affection  ;  by 
its  invariable  aggravation  on  muscular  exertion,  as 
well  as  mental  emotion  ;  and  by  the  particular  relipf 
obtained  at  first  from  bloodletting. — Disease  of  the 
Heart,  although  its  symptoms  may  be  mitigated  at 
one  period  and  aggravated  at  another,  is  however 
permanent ;  the  symptoms  are  never  entirely  absent ; 
and  they  may  at  any  time  be  renewed,  in  an  aggra- 
vated form,  by  muscular  exertion.  In  dubious  cases 
the  patient  maybe  made  to  7'un  up  stairs  ; — ^the  symp- 
toms of  an  organic  disease  of  the  heart  are  invari- 
ably aggravated  by  this  muscular  exertion,  the  puis- 
ation  of  the  heart  becoming  violent,  the  pulse  perhaps 
irregular,  the  respiration  exceedingly  difficult,  &c. 
circumstances  not  equally  observed  in  symptomatic 
derangements  of  the  functions  of  this  organ,  unless 
when  they  are  attended  with  great  debility,      TUere 

K 


74  THE  MIMOSIS  ACUTA. 

i§  almost  always^  too,  great  but  transitory  relief  froist 
bloodletting — in  a  degree  not  observed  in  the  symp- 
tomatic affections.* 

108  Case  XXIV.  Dr.  D.  aged  about  70.  He 
became  affected  witli  the  following  symptoms  : — loss 
of  flesh,  weakness,  tremor,  tendency  to  tears,  a  load- 
ed state  of  tlie  tongue,  mouth,  and  breath,  and  disor- 
der of  the  bowels  with  scanty  stools  ;  w^ith  these  affec- 
tions there  were  symptoms  which  led  to  the  idea  of 
Angina  Pectoris,  or  of  Dropsy  of  the  Pericardium. — 
From  the  use  of  gentle  rhubarb  purgatives,  with  ex- 
ercise in  the  open  air,  the  patient  gradually  recovered 
a  considerable  degree  of  strength,  tlie  general  health 
improved,  and  he  has  run  up  a  high  stair  case,  with 
considerable  activity,  and  without  feeling  any  of  his 
former  uneasy  sensations  about  the  heart.  This 
amendment  has  now  continued  at  least  a  year  and  a 
half. 

109.  Case  XXV.  Capt.  B.  aged  50,  was  sup- 
posed to  labour  under  an  Organic  Affection  of  the 
Heart,  induoing  palpitation  and  great  irregularity  of 
the  pulse,  for  many  years.  It  has  been  nearly  forgot- 
ten for  some  months,  and  he  has  suffered  exceedingly 
from  attacks  of  vertigo.  The  complexion  is  sallow  ; 
the  tongue  swollen,  lobulated,  indented,  and  loaded ; 
the  breath  tainted  ;  the  appetite  good  ;  the  digestion 

*  Sec  the  treatise  on  Diagxosis,  Part  II,  §   157. 


THE  DrAGNOSIS. 


;-' 


*eftea  impaired;  and  the  bowels  constipated.  His 
complaints  are  all  mitigated  by  a  course  of  purgative 
medicines  in  which  he  still  perseveres. 

110.  Case  XXVI.  Mr.  D.  of  L.  C  aged  34,  a 
farmer  and  grazier.  February  4,  1819.  Hix  weeks 
ago,  soon  after  lying  down  in  bed,  he  became  suddenly 
affected  with  an  indescribable  sensation  as  of  approach- 
ing dissolution ;  he  got  out  of  bed^  took  some  warm 
negus,  and  began  to  eructate  copiously  ; — he  had  pre- 
viously complained  of  vertigo, — once  of  pain  at  the 
stomach  ascribed  to  wind, — and  several  times  he  had 
asked  for  aloes  from  being  constipated.  Soon  after 
taking  tlie  negus,  palpitation  of  the  heart  took  place,, 
and  increased  to  a  considerable  degree  of  violence. 
Since  that  time  he  has  had  three  other  violent  attacks 
of  palpitation  ; — the  second  five  days  after  the  first, 
and  like  it,  almost  five  minutes  after  lying  down  in 
bed  ;  the  third  a  week  after  the  second,  at  night,  but 
before  he  was  gone  to  bed.  Since  ihese  periods  he 
lias  also  had  palpitation,  but  in  a  less  severe  degree. 
About  twenty  days  ago,  he  became  affected  with  flut-. 
tering,  referred  to  the  scrobiculus  cordis,  and  lower 
in  the  abdomen.  At  different  times  he  has  had  the 
following  symptoms  : — pain  at  the  stomach,  vertigo, 
pain  at  the  back  of  the  head,  restlessness,  want  of  sleep, 
with  starting,  twitching,  dreaming,  alarm,  and  des- 
pondency,— and  fear  of  immediate  dissolution  ;  some 
tremor,  and  several  times  wheezing  breathing;  he 
lias  felt  overcome  with  sleep,  which  has  induced  pain 


\^ 


76  THE  MIMOSIS  ACUTA; 

of  the  heart  and  palpitation,  and  a  feeling  as  if  the 
heart  would  burst. — A  fortni^^ht  ago  the  skin  was  dry^ 
the  tongue  much  loaded  and  swollen,  the  bowels  con- 
stipated, with  flatus  in  the  bowels,  the  motions  being 
very  offensive  and  dark  coloured,  and  the  water  high 
coloured  and  once  or  twice  with  much  sediment.  The 
appetite  ha*  been  good  all  along.  There  is  consider- 
able loss  of  flesh — The  tongue  is  now  clean  ;  the  flesh 
regained,  and  he  is  better  in  every  respect.  He  sleeps 
still  but  little.  A  short  time  after  this  report  this 
patient  became  affected  with  difficulty  of  urine.  He 
afterwards  became  subject  to  dyspepsia  for  several 
months  in  its  ordinary  form,  but  at  length  recovered 
completely. 

in.  Case  XXVIT.  Mr.  W.  aged  48,  from  sit- 
ing in  an  overheated  counting-house,  and  subsequent 
exposure  to  cold,  became  affected  by  the  following 
symptoms  : — The  countenance  was  rather  flushed, 
but  at  the  same  time  rather  cold  and  clammy.  The 
tongue  was  white,  loaded,  indented,  and  swollen.  He 
experienced  faintishness  when  upright,  and  could  not 
bear  to  approach  the  fire.  Little  headach  or  vertigo. 
The  pulse  was  rather  frequent,  and  remarkably  irreg- 
ular and  intermittent.  There  was  no  appetite.  These 
symptoms  gradually  declined  on  taking  an  emetic 
followed  by  ^  dose  of  calomel,  and  other  purgatives. 
The  affection  continued  about  eight  days.  The  tongue 
got  gradually  clean  from  the  edges  to  the  centre ;  the 
pulse  gradually  regular  and  of    natural  frequency  5 


/  THE  DIAGNOSIS.  77 

the  appetite  better ;  and  the  patient  could  in  a  few 
days  bear  the  upright  posture  and  being  near  the  fire. 
January  15,  1819. 

113.  The  cases  detailed,  §§  86,  87,  seem  to  have 
been  attended  by  fainting,  as  well  as  the  singular  affec- 
tion of  the  head  described.  Indeed  all  these  cases  are 
complicated  in  an  eminent  degree,  and  all  appear  to 
me  to  establish  the  propriety  and  the  importance,  in. 
a  practical  point  of  view,  of  the  denomination  I  have 
appropriated  to  them.  The  following  case  is  however 
still  more  particularly  a  case  of  fainting ;  it  is  one 
which  1  have  carefully  watched  ;  1  give  it  in  the  pa- 
tient's own  words  : — 

113.  Case  XXVIII.  Mr.  R.  H.  aged  64.  "I 
have  long  been  subject  to  a  sort  of  fainting  fit,  which 
attacks  me  very  suddenly  and  affects  me  in  an  extra- 
ordinary manner.  1  suddenly  appear  to  myself  to  be 
at  the  point  of  death,  and  to  have  lost  every  faculty. 
I  have  sometimes  completely  fainted  for  a  few  minutes, 
and  have  occasionally  vomited  ;  1  then  experience  a 
sense  as  of  a  stick  pressing  violently  upon  the  funda- 
ment. On  recovering,  a  copious  perspiration  bedews 
my  forehead,  and  I  am  extremely  pale,  and  feeble. 
About  seven  years  ago  Dr.  H.  suggested  to  me  that 
the  whole  of  these  complaints-  arose  from  a  disordered 
state  of  my  bowels,  and  that,  by  a  continual  recourse 
to  mild  purgatives,  they  might  be  prevented.  This 
opinion  I  have  found  to  be  true,  having  experienced 


78  THE  MIMOSIS  ACUTA. 

complete  relief  by  following  that  prescription/^  To 
this  account  of  the  patient's  sensations  I  add  the  fol- 
lowing one  of  the  appearances  in  an  attack  which  I 
witnessed.  He  was  taken  on  the  evening  of  the  9th 
of  January,  1819,  with  a  sense  of  hunger  succeeded 
by  severe  pain  of  the  stomach ;  when  I  saw  him,  the 
countenance  was  pale,  cold  and  clammy ;  the  feet 
cold ;  the  pulse  feeble  and  intermittent ;  the  pain 
much  increased.  I  gave  him  a  dose  of  ol  ricini,  and  a 
glass  of  hot  brandy  and  water.  He  was  soon  relieved, 
and  perfectly  so  on  the  operation  of  the  medicine.* 

4.  Of  Affections  of  the  Stomach  and  Bowels. 

114.  The  affections  of  the  Stomach  and  Bowels  in 
the  Mimosis  Acuta,  besides  those  comprised  in  the 
more  general  disorder,  are  numerous.  They  are  chief- 

ly  the  following  : hiccough,  hcematemesis,  melcena^ 

and  pain  in  differerent  parts  of  the  tract  of  the  ali- 
mentary canal,  assuming  the  different  characters  about 
to  be  described. 

115.  The  complication  of  Mimosis  with  Hiccough, 
§  34,  has  been  sufficiently  noticed  in  Case  X.  But 
as  this  symptom  is  sometimes  extremely  severe,  and 
as  vomiting  of  food  is  sometimes  superadded  in  an 
extraordinary  degree,  I  think  it  proper  to  detail  a 
case  or  two  of  this  affection. 

•  See  Bell's  Anatomy,  V.  II,  p.  240;  Abefnethy,  V.  I.  p.  212;  Farre's  Patlt, 
Researches,  Ess.  I,  p.  46,  &c. 


THE  DIAGNOSIS.  79 

116.  Case  XXIX.  The  first  case  is  an  instance 
of  violent  Hiccough,  Mr.  C.  aged  about  50,  of  Slea- 
ford,  Lincolnshire,  after  feeling  chilly  and  weak,  a& 
he  supposes,  from  cold,  first  experienced  Hiccough 
on  December  the  18th,  1817,  at  5  p.  m.  It  was  re- 
moved about  11  p,  m.  by  a  little  gin  and  water.  It 
returned  on  the  19th  at  5  a.  m. ;  it  was  removed  for 
half  an  hour  by  a  little  rum,  but  recurred  and  con- 
tinued witli  little  interruption  through  the  day.  On 
the  SOth,  the  Hiccough  was  arrested  for  a  little  time 
by  laudanum  and  musk,  but  it  again  returned.  On 
the  Slst,  a  blister  was  applied  over  the  stomach,  but 
the  Hiccough  continued,  and  was  accompanied  on 
this  day  by  a  singular  sort  of  crowing  noise  during 
inspiration.  On  the  SSnd,  snuff  was  recommended, 
which  arrested  the  Hiccough  for  a  short  time.  The 
affection,  however,  continued  in  a  violent  form  through 
the  night.  On  the  23d,  an  emetic  was  given,  and 
six  leeches  and  a  blister  were  applied  ;  the  Hiccough 
ceased  for  a  time,  but  recurred  with  the  crowing  and 
continued  during  the  night,  preventing  the  patient 
from  lying  in  bed.  The  life  of  the  patient  was  thought 
to  be  in  imminent  danger.  The  affection  still  contin- 
ued on  the  S8th,  when  I  recommended  purgative 
doses  of  calomel  and  infus.  sennse,  from  the  first  ope- 
ration of  which  the  Hiccough  entirely  ceased  with 
the  exception  of  a  slight  return  once  more  on  the  S9th. 
The  purgative  was  continued  for  some  time,  by  means 
of  which  a  loaded  state  of  the  tongue  and  of  the  bow- 
els was  removed.     I  should  have  also  stated  that  a 


80  THE  MIMOSIS  ACUTA. 

little  opium  and  carbonate  of  ammonia  were  given  ^ 
but  to  these  remedies  1  did  not  ascribe  much  effect. 


117.  Case  XXX.  Mr.  G.  C.  aged  S6.  Septem- 
ber  6th,  18 17.  This  patient  had  an  attack  similar  to 
that  about  to  be  described,  eight  years  ago  ;  it  contin- 
cd  several  weeks.  The  present  attack  commenced 
in  March  last,  and  has  continued  in  a  more  or  less 
{severe  form,  since  that  period.  After  eating  he  be- 
comes affected  with  chilliness,  pain  at  the  stomach, 
nausea,  and  tumidity  of  the  abdomen  ;  he  is  then  sud- 
denly affected  with  vomiting,  and  the  rejection  of 
much  mucus,  or  there  are  eructation,  retching,  and 
vomiting.  He  remains  poorly  for  about  an  hour, 
during  which  period  there  is  some  pain.  lie  then 
pursues  his  usual  occupation.  His  complaint  sgain 
recurs  on  eatins:-  He  is  feeble  and  has  lost  some  de- 
gree  of  flesh.  The  pulse  is  about  80,  and  rather  fee- 
ble. The  tongue  is  white  and  loaded.  The  bowels 
constipated.  The  hands  are  apt  to  become  cold. — 
The  affection  yielded  to  the  remedies  to  be  noticed 
hereafter. 

118.  Case  XXXI.  Mr.  B.  A.  aged  S4.  He  was 
affected  in  the  following  manner  about  six  months 
ago ;  the  attack  was  less  severe  than  the  present,  and 
continued  one  month ;  the  affection  then  ceased,  but 
it  returned  ten  days  ago.  At  present,  September  9th, 
I8I7,  he  becomes  affected  with  vomiting  and  retch- 
ing after  eating:  with  these  symptoms  hiccough  is 


THE  DIAGNOSIS.  Bi 

sometimes  conjoined,  and  this  is  occasionally  of  the 
most  violent  kind,  affecting  him  like  a  spasui^  draw- 
ing the  body  awry,  and  sometimes  throwing  him  off 
his  chair ;  he  suffers  such  excruciating  pain  as  to  in- 
duce a  flow  of  tears  ;  and  the  breathing  is  irregular, 
rapid,  and  anxious.  The  tongue  is  loaded  ;  the  bow- 
els costive.  The  pulse  is  nearly  natural,  'i  here  are 
weakness  and  some  loss  of  flesh. — This  affection  was 
removed  by  the  remedies  to  be  noticed  hereafter.  It 
recurred  after  a  time  and  again  yielded  to  medicine. 
The  patient  became  attacked  by  a  spiisniodic  affection 
of  the  left  arm,  so  as  to  deprive  him  of  the  use  of  the 
hand.  1  his  affection  yielded  to  the  same  purgative 
remedies,  and  has  since  remained  well. 

119.  Case  XXXIL  Mr.  J.  R.  aged  31.— He  i^ 
naturally  thin  and  feeble.  He  is  at  present  affected 
with  vomiting  after  meals,  without  hiccough.  The 
pulse  is  natural.  The  tongue  white.  The  bowels 
costive. — The  affection  yielded  to  the  purgative  rem- 
edies. 

120.  This  affection  must  be  carefully  distinguish- 
ed from  Organic  Disease  of  the  Stomach.  Its 
History, — its  cessation  for  a  period  and  subsequent 
recurrence^ — its  violence  even  at  the  beginning, — itii 
spasmodic  character,  &c.  are  sufficiently  contrasted 
with  the  slow  formation  and  insidious  progress,  the 
continued  form,  the  regularly  progressive  course,  and 
the  unceasing  character  of  organic  disease.     It  is  fur- 


H2,  THE  MlMOSl^  ACUTA. 

ilier  distinguished  by  some  of  the  symptoms  of  the 
Mimosis  Acuta; — even  the  hiccough  is,  I  think,  a 
rave  occurrence  in  the  organic  affection,  which  is  ra- 
ther denoted  by  pain,  which  gradually  increases  after 
eating  until  the  stomach  is  unloaded  by  vomiting.* 

IS  I.  Mel.ena,  ^  34,  is  an  affection  of  much  more 
frequent  occurrence  than  is  generally  imagined.  Its 
existence  is,  of  course,  only  ascertained  by  accident. 
But  I  have  found,  on  inquiry,  that  it  lias  occurred  in 
a  great  number  of  the  cases  of  Mimosis  Acuta  whicli 
I  have  treated.  It  occurs  also  in  the  other  forms  of 
Mimosis  to  be  descriljed  hereafter.  It  has  been  a 
very  frequent  occurrence  during  the  present  summer 
of  1818.  AVith  Melsena,  H.iiMATEMEsis  is  not  un- 
frequcutly  combined.  The  two  cliseasess  appear  to  be 
similar  affections  of  different  parts  of  the  alimentary 
canal.  The  discharge  of  blood  varies  greatly  in  quan- 
tity and  appearance.  It  yields  in  general  to  the 
employment  of  purgative  medicines,  with  the  pil. 
hydrarg.  See  Cases  III.  &  XI.  In  several  cases  the 
patient  has  awoke  in  the  morning  with  blood  in  the 
mouth. 

122.  lyiave  enumeratetl^  as  the  next  complication 
of  Mimosis  Acuta,  Pain  in  the  Epigastric,  or  in  one 
of  the  Hypochondriac,  or  Chondiliac  Hegions,  §  34. 
This  pain  is  so  common  that  I  think  few  cases  of  the 
Mimosis  occur  without  some  degree  af  it.     There  are 

•  See  fintUer  the  treatise  on  Diagnosis,  Part II,  §§  ISr,  188. 


THE  DIAGNOSIS.  83 

sometimes  all  the  symptoms  of  an  attack  of  Gall 
Stones.  Sometimes  there  is  severe  pain  extendiiiii; 
across  the  false  ribs,  leading  to  the  suspicion  of  In- 
flammation OF  THE  Pleura,  or,  together  Avitli 
the  affection  of  the  complexion,  it  leads  to  the  sus- 
picion of  Inflammation  or  Disease  of  the  Liv- 
er. And  its  situation  sometimes  induces  an  opinion 
that  the  Spleen  is  affected.  It  is  distinguished  by 
being  liable  to  recede  and  to  recur,  by  varying  its 
situation,  frequently  by  being  unattended  by  tender- 
ness on  pressure  when  the  examination  is  made  witli 
proper  care,  and  by  conjoining  the  characters,  §§  ^, 
21,  et  seqq.^ — This  pain  has  appeared  to  me  to  havt 
its  seat  in  the  Colon,  some  part  of  whose  c^our^  it 
occupies,  §  30, — from  the  hollow  of  one  ilium  round 
to  that  of  the  other. — Pain,  tenderness,  and  even  tu- 
mor, frequently  exist  in  the  course  of  this  intestine 
from  the  remora  of  scybalai ;  the  case  is  perhaps  con- 
sidered to  be  an  instance  of  organic  enlargement  of 
some  viscus  in  this  course  ;  the  cause  being  removed 
by  thejaction  of  aperient  medicines  and  by  friction^ 
the  tumor  is  supposed  to  be  discussed  by  the  pil.  and 
the  ung.  hydrarg. — Pain  in  some  part  of  the  course 
of  the  colon,  but  especially  in  the  seat  of  the  sigmoid 
flexure,  often  attends  and  denotes  a  loaded  or  contract- 
ed state  of  the  Rectum  :  the  real  state  of  this  bowel 
must  be  ascertained  by  an  examination,  and  by  the 
aid  of  enemata. 

*  See  further  .the  tfoatise  on  Diagnosis,  Part  II,  pp.  ir9— 182,  254. 


8:1*  THE  MIMOSIS  ACUTA. 

1^3.  Case  XXXIII.  Mr.  L.  aged  40.  Novem- 
ber, 1818.  When  I  first  saw  him  he  laboured  from 
tenderness,  pain,  and  fulness  at  the  scrobiculus  cordis. 
A  similar  pain  had  affected  the  right  side, — and  had 
been  mitigated  and  had  recurred  several  times. — The 
countenance  was  rather  leucophlegmatic  and  bloated  ; 
the  tongue  loaded ;  the  breath  tainted  ;  the  bowels 
coustipHted  and  medicines  had  acted  inefficiently  ;  the 
pulse  natural  in  frequency.  He  had  suffered  for  sev- 
eral weeks  previously  to  the  attack,  from  lowness  of 
spirits  ;  tendency  to  shed  tears  ;  tremor  ;  nervousness  ; 
vertigo ;  fluttering ;  and  a  loaded  state  of  the  tongue, 
breath,  and  bowels.  He  was  much  relieved  by  leeches 
and  still  more  effectually  by  the  copious  action  of 
draughts  with  ol.  riciui,  and  pills  with  the  pulvis 
jalapse. 

124,  Case  XXXIV,  Miss  B.  of  K.  aged  17,  con- 
suited  me  in  August,  for  a  severe  pain  with  tender- 
ness in  the  left  hypochondriac  and  chondiliac  re- 
gions ;  the  tongue  was  loaded,  swollen,  indented,  and 
with  enlarged  papillae,  the  gums  red  and  tumid,  the 
breath  extremely  fostid,  the  bowels  were  said  not  to 
be  much  disordered ;  the  countenance  was  pale  and 
swarthy ;  there  was  some  loss  of  flesh  :  the  general 
health  was  manifestly  impaired.  The  pain  was  al- 
most immediately  relieved  by  active  purgative  medi- 
cines ;  and  the  health  was  restored  by  a  perseverance 
in  milder  doses  of  the  same  remedies. — The  symptoms 
had  led  to  the  apprehension  of  organic  disease.  They 
had  subsisted  for  several  weeks;  or  even  months. 


THE  DIAGNOSIS.  SSf 

125.  Case  XXXV.  A.  B.  aged  S5.  She  com- 
plains of  pain  in  the  left  iliac  region,  accompanied  by- 
considerable  tenderness.  It  was  relieved  by  employ- 
ing the  rectum  of  Scybalse  by  means  of  an  enema. 

126.  It  scarcely  appears  necessary  to  do  more  than 
refer  to  the  enumeration  of  Constipation,  Diarrhoea, 
and  Tenesmus,  as  occurring  in  the  Mimosis  Acuta, 
§  24;  the  source  of  these  aftections  must  be  traced 
to  the  original  disorder, — and  it  must  be  distinguished 
from  a  diseased  state  of  the  rectum. — The  constipa- 
tion is  frequently  attended  by  pain  deep  in  the  sa- 
crum, which  is  apt  to  be  aggravated  by  the  move- 
ment of  a  carriage  in  travelling. — The  Diarrhoea  in- 
duces frequent,  scanty,  liquid,  foetid  stools,  often  with 
mucus,  sometimes  with  more  or  less  of  blood  ;  there 
are  also  in  different  instances,  gripings,  tenderness, 
and  Tenesmus.  The  Diarrhoea  often  occcurs,  recedes, 
and  recurs  during  the  course  of  the  Mimosis  ;  the 
latter  affection  is  apt,  however,  to  be  overlooked,  and 
the  former  to  be  treated  as  a  primary  affection  and 
confounded  with  other  kinds  of  Diarrhoea, 


127.  Case  XXXVI.  Mr.  R.  aged  46.  He  has 
suffered  from  the  symptoms  of  the  Mimosis  Acuta 
during  three  months.  The  affection  varied  much  in 
severity  at  different  periods.  There  were  unusual 
weakness,  faintiness,  weariness,  aching  pains,  loss  of 
flesh,  vertigo,  and  affection  of  the  sight,  a  most  tainted 
breath,  swollen  gums;  ptyalism;  a  loaded  and  swollen 


86  THE  MIMOSIS  ACUTA. 

tongue,  coldness  of  the  hands  and  feet^  &c.  Seven 
days  ago,  a  regular  state  of  the  bowels  is  said  to  have 
yielded  to  Diarrhoia,  with  frequent,  scanty,  mucous, 
and  various  stools,  which  are  sometimes  foetid,  some- 
times with  much  filamentous  substance,  and  sometimes 
bloody.  There  are  great  indisposition  and  an  inca- 
pacity for  the  slightest  exertion.— This  affection  yields 
slowly  to  the  pil.  hydrarg.  with  gentle  purgative  me- 
dicines, the  stools  becoming  gradually,  first  faeculent; 
and  then  more  and  more  natural. 

1^.  Icterus  has  occurred  in  six  persons,  in 
connexion  with  symptoms  of  Mimosis  Acuta,  within 
the  last  year.  It  has  appeared  principally  in  the  se- 
dentary ;  it  has  seemed  to  depend  on  a  loaded  state  of 
the  intestines  ;  and  it  has  yielded  to  active  doses  of 
calomel  and  other  purgative  medicines.  This  appears 
to  be  by  far  the  most  frequent  form  of  Icterus,  and  is 
observed  in  persons  of  all  ages, — in  very  early  youth, 
4iud  in  adult  age. 

1S9.  Cases  XXXVII.  and  XXXVIII.     D.  G, 

and  S.  P.  aged  about  28,  and  fellow-workmen  in  the 
same  shop  of  lace-frames,  have  each  been  affected 
with  Icterus  supervening  on  symptoms  of  Mimosis 
Acuta.  The  Icterus  was  relieved  in  both  by  active 
doses  of  purgative  medicines,  and  the  primary  affec- 
tion has  been  totally  removed,  and  any  recurrence  of 
it  obviated,  by  perseverance  in  milder  doses  of  the 
same  remedies. 


THE  DIAGNOSIS.  8? 

130.  Case  XXXIX.  Miss  W.  aged  16,  of  seden- 
tery  habits,  was  observed  during  several  months,  to 
lose  her  wonted  appearance  of  health  and  strength  ; — 
the  countenance  became  somewhat  paler,  and  thinner  ; 
the  mouth,  tongue,  and  breath,  loaded  and  disagree- 
ble,  and  the  bowels  somewhat  constipated.  At  length 
Icterus  supervened,  the  skin  and  tunica  albuginea  be- 
came greatly  tinged  with  yellow,  the  urine  deep  co- 
loured, the  motions  pale,  and  the  bowels  torpid.  The 
affection  was  soon  removed,  and  the  health  greatly 
improved,  by  efficient  purgative  medicines,  and  she 
is  now  ruddy,  plump,  and  active. 

131.  Case  XL.  Mr.  B.  aged  55,  has  twice  la- 
boured under  Icterus  as  a  form  of  Mimosis,  Once  he 
was  affected  with  vertigo,  fluttering,  nervousness,  in- 
termittent pulse,  a  loaded  state  of  the  breath,  mouthy 
and  bowels,  and  Icterus  ;  he  was  incapable  of  exertion, 
and  perspired  profusely  on  attempting  it ;  the  second 
time  there  were  violent  pain  of  the  head,  and  excruci- 
ating pain  in  the  epigastre  extending  to  the  back ;  in 
lioth  cases  the  Icterus  soon  yielded  to  purgative  medi- 
cines, and  in  both  there  wxre  the  usual  symptoms  of 
the  Mimosis  Acuta. 

133.  Sometimes  there  are  Symptoms  of  an  Af- 
¥ECTioN  OF  THE  Bl ADDER.  The  Mimosis  Acuta 
has  begun  with  these  symptoms  in  several  instances,^ 
and  it  has  been  conjoined,  with  them  in  some  part  of 
its  course.     In  one  case  the  symptoms  of  affection  of 


88  THE  MIMOSIS  ACUTA. 

the  bladder  seemed  to  depend  on  a  loaded  and  irrita 
ble  state  of  the  lower  intestine,  and  soon    yielded  to 
the  remedies  of  the  Mimosis  Acuta.*    8ee  §.  110. 

133.  In  some  instances  there  have  been  all  the 
appearances  of  an  attack  of  Tic  Doulouueux  with 
the  symptoms  of  the  Mimosis  Acuta,  the  tongue,  the 
breath,  the  bowels,  and  the  urine  being  exceedingly 
loaded  and  tainted.  In  two  cases  the  pain  was  prompt- 
ly removed  by  emetic  and  purgative  medicines.  One 
of  them  was  of  the  most  severe  and  excruciating  kind. 

134.  The  next  complications  with  the  Mimosis 
Acuta  to  be  noticed,  arc,  Some  Convulsive  and  Spasmo- 
dic Affections.  I  shall  illustrate  this  subject  simply 
by  the  brief  detail  of  cases  in  exemplification  : — 

13.^,  Case  XLI.  N.  M.  aged  about  it,  was  sud- 
denly seized  in  the  following  manner  : — the  face  and 
limbs  were  affected  with  convulsive  motions ;  the  coun- 
tenance was  extremely  distorted,  the  moutli,  nostrils, 
and  clieeks  being  violently  and  convulsivel}'^  drawn  to 
the  right  side ;  several  persons  were  occupied  in  re- 
straining the  violent  convulsions  of  the  limbs  ;  the 
tongue,  breath,  and  bowels  were  loaded.  The  imme- 
diate attack  was  relieved  by  opening  the  temporal 
artery,  and  any  return  was  prevented  I)y  the  use  of 
purgatives. 

*  See  EpII's  Reports,  V.  11.  p.  64- 


THE  DIAGNOSIS.  89 

136.  Case  XLII.  Mr.  A,  of  B.  became  affected 
with  iwa  irregular  spasmodic  distortion  of  the  moatii, 
which  was  drawn,  from  time  to  time,  into  the  most 
extraordinary  forms.  The  tongue  was  loaded,  the 
breath  tainted,  and  the  bowels  disordered. — The  af- 
fection was  removed  in  a  few  days  by  mild  purgative?, 
consisting  principally  of  the  pil.  hydrarg.  and  rhu- 
barb. 

137.  €ase  XLIII.  Mr.  B.  is  subject  to  a  contin- 
ued state  of  Mimosis,  which  is  liable,  from  cold  or 
other  causes,  to  be  considerably  augmented.^  At  these 
times,  Mr.  B.  experiences  a  considerable  degree  of 
hesitation  and  difficulty  in  articulation,  an  affection 
which  invariably  recedes  with  the  primary  disorder. 

138.  Case  XLIV.  Mr.  A.  of  C.  became  affected 
with  violent  and  most  painful  cramps  of  the  calf  of 
the  right  leg  and  of  the  thigh.  The  muscles  of  the 
thigh  were  drawn  into  a  perfect  ball.  The  spasms 
were  somewhat  continued,  and  so  violent  as  to  flush 
the  face,  cause  the  respiration  to  be  forcibly  arrested, 
and  induce  great  expression  of  pain  and  suffering. 
The  tongue  was  extremely  loaded  ;  the  breath  foBtid ; 
the  digestive  organs  much  disordered.  He  was  or- 
dered half  a  drachm  of  ipecacuan,  and  a  calomel 
purge,  and  was  immediately  relieved. 

139.  Case  XLV.      Mr.  H.  of  N.  on  the  Soar, 
had  been    affected   during  four  weeks,  with  violent 

M 


90  THE  MIMOSIS  ACtJTA. 

and  painful  spasmodic  contractions  of  the  muscles  o^ 
the  right  thigh.  This  thigh  had  long  been  diseased, 
a  disease  of  the  liip,  in  early  youth,  having  impeded 
its  growth,  and  the  muscular  substance  about  the 
thigh,  having  more  recently,  although  not  within  the 
last  six  years,  formed  the  seat  of  suppurations. — The 
spasms  were  momentary  only,  but  extremely  severe, 
and  tlie  pain  excruciating ;  they  were  apt  to  be  re- 
peated on  moving,  or  on  retaining  one  position  for 
too  long  a  period  ;  they  were  also  induced  by  any  sur- 
piise  or  hurry  of  mind, — by  the  fear  of  being  touched 
on  this  i^rt, — and,  once,  most  severely,  on  being 
startled  by  a  stone  thrown  by  a  boy  against  an  outer 
wall  near  his  bed.  The  sleep  was  interrupted,  and 
but  a  temporary  respite  was  obtained,  and  this  at  first 
only,  by  laudanum  with  aether.  The  tongue  was  lit- 
tle affected  ;  he  Was  low-spirited  and  nervous  ;  the 
bowels  were  loaded  and  disordered.  His  complaint 
was  growing  daily  more  and  more  severe. — It  was 
removed  in  about  a  week,  by  the  pil.  hydrarg.  given 
every  second  night,  the  sulphat  of  magnesia  with  in- 
fus.  sennse,  every  morning,  and  the  effervescing  saline 
medicine.  He  has  now,  July  3rd,  been  in  a  state  of 
progressive  convalescence  for  a  fortnight,  recovering 
gradually  the  flesh  and  strength  he  had  lost  before. 
This  patient  still  remains  free  from  complaint,  Sep- 
tember 18th. 

140,  Case  XLVI.     Miss  M.  aged  15.     She  has 
])een  subject,  during  three  springs,  to  the  following 


THE  DIAGNOSIS.  91 

affection,  which  is  said  to  have  yielded  spontane- 
ously each  time,  in  the  course  of  about  three  months 
after  its  commencement.  The  hands,  and  especially 
the  right  hand,  are  apt  to  be  affected  witli  a  rather 
continued  spasmodic  contraction  ;  they  are  not  quite 
closed,  but  any  thing  held  in  them  is  not  easily  re- 
moved from  the  grasp.  The  contraction  comes  on, 
recedes  and  recurs,  without  any  warning.  The  tongue 
is  much  loaded,  and,  with  the  gums,  considerably 
swollen,  and  it  is  marked  by  the  teeth;  the  breath  is 
fcetid;  the  bowels  confined  ;  the  catamenia  have  not 
yet  appeared.  The  affection  has  been  removed  by  a 
month's  perseverance  in  purgative  medicines.* 

141.  Case  XLVII.  J.  A.  aged  10,  has  been  sub- 
ject for  a  considerable  time,  to  the  following  affection  : 
— the  head  is  moved  rapidly  in  a  repeated,  rotatory 
manner,  from  side  to. side  ;  the  arms  and  legs  are  sub- 
ject to  a  similar  rapid  spasmodic  action  of  their  mus- 
cles ;  when  he  sits  down,  the  rectus  muscle  of  each 
thigh,  but  especially  of  the  right,  leaps  continually, 
a  movement  best  felt  on  applying  the  hand  about  their 
middle  part. — This  affection  was  gradually  removed 
by  calomel  purgatives. 

I'^S.  Case  XLVIII.  I  hav<5  seeii  a  similar  move- 
ment of  the  head  in  a  married  woman  about  40, 
which  was  increased  by  any  mental  affection,  and  par- 
4ic^l^rly  when  remarked  by  a  stranger.     This  patient 

*  See  a  case  iri  Bateroan's  tJepDi-ts,  p.  11?, 


9S  THE  MIMOSIS  ACUTA. 

did  not  take  any  medicine. — I  have  also  been  inform- 
ed of  a  similar  instance  of  spasmodic  affection  in  a 
lady  about  50. 

143.  Trismus ;  a  state  of  locked  hand  ;  and  a  contin- 
ued cramp  of  the  foot,  are  not  very  uncommon  in  con- 
nexion with  a  similar  state  of  disorder ;  but  it  does 
not  appear  necessary  to  particularize  these  affections. 

144.  Convulsive  and  Spasmodic  affections  may 
anse  from  Disease  within  the  head,  from  Local  Irri- 
tation, from  a  state  of  Mimosis^  &c.  and  it  is  of  the 
utmost  importance  to  ascertain  the  source  and  seat  of 
the  affection, — ^^  neque  enim  credo,  posse  eum  scire, 
quomodo  morbos  curare  conveniat,  qui,  unde  hi  sint, 
ignoret.'"^ 

145.  In  place  of  a  spasmodic  affection,  there  is 
sometimes  Paralytic  Weakness  of  the  muscles,  espe- 
cially of  the  lower  extremities.  This  affection  very 
insidiously  and  gradually  deprives  the  patient  of  the 
use  of  the  limbs.  It  is  often  attended  by  a  feeling  of 
stiffness,  increased  on  exposure  to  cold  ;  and  there  are 
sometimes  twitchings,  or  slight,,  rapid  contractions  of 
the  muscles.  The  paralysis  has  in  different  cases  af- 
fected the  bladder,  tlie  sphincters,  and  the  upper  ex- 
tremities even. 

146.  This  species  of  Paralytic  Affection  must 
be  cautiously  distinguished  from  Paralysis  arising 
from    UisEASE  of  the  Head  ob  Spine.      The  di- 


THE  DIAGNOSIS.  OS 

agnosis  must  be  established  by  observing  the  History 
and  Symptoms,  and  the  Effect  of  Remedies,  and  by 
contrasting  them  with  the  characters  of  local  affection 
of  the  Head  and  of  the  Spine,  especially  the  latter.* 
The  presence  of  the  symptoms  of  Mimosis,  and  the 
absence  of  discoverable  local  disease,  should  lead  to 
the  trial  of  the  remedies  of  the  former  affection ; 
and  this  experiment  will  afford  another  source  of 
Diagnosis. 

147.  There  is  a  singular  affection,  which  arises 
from  a  disordered  state  of  the  stomach  and  bowels 
which  has  not  I  think  been  noticed.  ^Ihe  face,  and 
some  parts  of  the  surface  of  the  hodijy  become  sudden- 
ly swollen  and  puffed, 

14S.  In  one  case  the  face  and  eye-lids  were  greatly 
swollen  and  disfigured.  The  patient  had  been  at  a 
feast,  and  felt  indisposed  some  days  before.  In  about 
half  an  hour  the  swelling  had  begun  to  subside  a  lit- 
tle 5  and  it  was  totally  removed  by  an  emetic  and 
purge.  This  patient  had  had  a  similar  affection  a 
year  and  half  before. 

149.  In  another  case  the  face,  surface  of  the  chest, 
&c.  had  become  suddenly  and  enormously  puffed  up. 
The  extremities  were  cold,  the  pulse  almost  impercep- 
tible, and  the  patient  appeared  to  be  sinking.  The 
attack  was  compared  to  an  explosion.  The  affection 
was  removed  by  an  emetic  and  purgative  medicine* 

*  See  the  tceatise  on  I^iAGjrosis,  Part  II.  ^  206.  aud  particularly  Abcrnethv, 
V.I.  p.-85.       , 


04  THE  MIMOSIS  ACUTA. 


III.  THE  LOCAL  COMPLICATIONS. 

150.  In  §  41,  I  have  enumerated  some  Topical  Af, 
fections  as  occurring  in  cases  of  Mimosis ;  they  are 
principally  if  not  exclusively  observed  iailiG  protracted 
instances  of  that  affection.  1  do  not  deem  it  necessary 
to  give  any  illustrations  of  those  affections  ;  these  will, 
I  think,  be  afforded  by  each  practitioner's  own  experi- 
ence. I  shall  only  add  here  an  account  of  a  diseased 
appearance  of  the  Prolabia,  and  of  an  ulcerated  state 
of  the  Tongue,  which  I  do  not  remember  to  have 
seen  described. 

151.  The  first  is  an  affection  of  the  Prolabium  and 
immediately  adjoining  skin.  It  consists  of  a  repeated, 
dry,  splitting,  and  exfoliation  of  the  cutis  of  these 
parts,  and  occupies  a  ring  of  about  one  fourth  of  an 
inch  diameter,  all  round  the  mouth ;  it  varies  in  seve- 
rity at  different  times  ;  and  it  is  generally  long  contin- 
ued.— I  have  seen  this  affection  in  a  boy,  in  a  young 
lady  aged  15,  in  two  mamed  ladies,  and  in  a  servant. 
It  sometimes  occupies  severely  the  whole  of  the  pro- 
labium and  a  portion  of  the  adjoining  skin  ;  and  Jt  is 
sometimes  more  partial  and  less  severe. 

153.  Case  XLIX.  The  case  of  ulceration  of  the 
tongue  occurred  in  W.  P.  aged  27,  framework-knit- 
ter. Upwards  of  three  months  ago  a  small  deep  ul- 
cer formed  near  the  point  and  another  on  one  side  of 


THE  LOCAL  COMPLICATIONS.  09 

the  tongue.  In  about  three  weeks  six  other  ulcers 
formed  in  different  parts  of  the  surface  of  the  tongue. 
He  took  emetic  and  purgative  medicines,  which  near- 
ly removed  the  affection,  the  ulcers  soon  healing* 
In  a  week  the  affection  again  returned,  in  the  form 
of  a  hard  lump  which  suppurated  leaving  a  deep  ulcer. 
The  tongue  swelled  and  was  loaded ;  and  there  was 
a  copious  flow  of  saliva.  I  first  saw  him  four  weeks 
ago.  The  tongue  was  swollen,  loaded  and  foul. 
There  were  two  deep  ulcers,  one  near  the  point,  the 
other  on  one  side.  On  the  Ifft  side  of  the  middle  of 
the  tongue  there  was  a  hardness  about  the  size  of  a 
nut ;  this  afterwards  suppurated  and  formed  a  similar 
ulcer.  The  gums  and  health  not  much  affected.  To- 
day, August  28,  the  ulcer  at  the  point  of  the  tongue 
is  better,  and  the  tongue  is  cleaner.  The  others  are 
much  the  same.  In  a  few  weeks  the  ulcers  healed 
under  the  influence  of  emetic  and  purgative  medicines. 


96  THE  MIMOSrS  ACUTA. 


IV.  NOTE  OX  A  C  AC  HECTICAL  FORM  OF 
MiMOSIS. 


153.  The  Mimesis  Acuta  has  appeared  to  degen- 
erate in  some  cases  into  a  state  of  Cachexia,  and 
has  been  complicated  not  only  with  the  diseases  enu- 
merated, §  41,  but  with  other  morbid  affections, — 
especially  of  the  skin,  the  mouth  and  throat,  the  pe- 
riosteum, the  absorbent  glands,  &o.  Some  of  these 
have  resembled  syphilitic  affections ;  others  have  ex- 
hibited very  different  appearanees. 

1.54.  This  subject  is  full  of  interest,  and  still  pre- 
sents a  wide  and  extensive  field  for  inquiry.  I  may 
perhaps  be  permitted  to  recommend  to  the  young 
student  a  careful  perusal  and  comparison  of  the 
works  referred  to  below;*  and  of  the  following  Case 
with  those  given  by  Willis,  de  Scorbuto,  Cap.  Xf, 
by  Mr.  Abernethy,  on  Diseases  resembling  Syphilis, 
Sect.  Ill,  and  in  Dr.  Bateman's  Reports,  p.  259. 

±55.  Case  L.  E.  M.  aged  35,  a  framework- 
knitter,   tall,    stout   and   healthy,  was   employed  in 


•  Willis,  and  the  cotemporary  writers,  on  Scorbutus  ;  tlie  essay  on  tlie  accep- 
tation of  the  term  Scorbutus,  Edinb.  Med.  Journ.  V.  xvi,  p.  20,4  ;  AI)ernethy  on 
the  Constitutional  Origin  of  Local  Diseases,  and  on  Pseudo-Syphilis;  Pearson  ou 
the  Cachexia  Syphiioidea  ;  Willan's  Reports,  on  Astlienia  ;  Dr.  Eateman's  Re- 
ports, on  Asthenia,  and  on  the  Cachexia  Syphiioidea;  Dr.  Philip's  paper  already 
referred  to,  p.  63 ;  Dr.  Hennen's  paper  in  the  Edinburgh  Medical  Journal,  Vol. 
XIV,  p.  201 ;  Dr.  Ayre  on  Marasnaus, — on  ozsena  ;  Dr.  Crampton's  pa^er  in  the 
Dublin  Hospital  Reports,  V.  I ;  he.  kc. 


IN  A  CACHECTIC  FORM.  97 

1815,  in  the  most  active  and  laborious  manner,  in 
hay-making ;  he  was  exposed  to  great  heat,  under- 
went great  fatigue,  perspired  profusely,  and  drank 
copiously  of  beer  and  ale.  He  became  affected  with 
weakness,  listlessness,  loss  of  flesh,  nocturnal  perspi- 
ration,— headach  and  vertigo, — loss  of  appetite  aud 
Icterus,  with  pale-coloured  stools  and  deep-coloured 
urine. — He  recovered  from  these  complaints,  but  in 
the  year  1816  had  the  misfortune  to  break  his  leg. 
In  consequence  of  this  acciilent  and  the  subsequent 
confinement,  he  became  and  remained  indisposed, 
and  gradually  lost  flesh,  and  from  14st.  weighed  be- 
tween l^st.  and  13st.  only,  and  experienced,  on  tak- 
ing cold,  a  loss  of  appetite  and  strength,  with  an 
inability  to  work,  not  known  before.  In  >ioveniber, 
1817,  he  underwent  much  bodily  exertion,  and  re- 
mained exposed  to  the  cold  and  damp.  He  took 
cold,  and  became  affected  with  hoarseness,  sore  throat, 
and  cough,  with  cedema  of  the  ankles.  These  symp- 
toms ceased,  except  the  oedema,  which  receded 
however  gradually,  but  he  remained  affected  with  the 
following  complaints  which  are  copied  from  his  own 
account  of  them:— ^ loss  of  flesh,  and  of  strength;  a 
feeling  of  internal  weakness  ;  feverishness,  a  pitched 
and  dry  state  of  the  throat,  and  sometimes  of  the 
tongue ;  sensibility  to  cold,  chilliness,  tendency  to  per- 
spiration,— especially  in  the  night ;  headach  ;  sleepi- 
ness ;  dulness  of  spirits  ;  nervousness  ;  fluttering  at  the 
heart  and  about  the  stomach ;  cough ;  dyspnoea ;  a 
clammy  tongue  and  mouth,  and  foetid  breath :  loss  of 


9S  THE  IVIIMOSIS  ACUTA. 

appetite,  sense  of  load  at  the  stomachy  occasional  re- 
jection of  food,  constipation,  and  pain  in  the  chondi^ 
liac  regions.' — This  patient  became  much  better  from 
the  use  of  gentle  purgatives  of  calomel,  rhubarb,  and 
Epsom  salt.  But  in  August,  1818,  he  became  af- 
fected with  severe  and  continued  diarrhoBa,  with  a 
loss  of  jBiesh  fioni  list.  2lbs.  to  lOst.  6lbs.  and  loss  of 
strength,  and  aching  and  weariness,  and  pain  in  the 
shoulders,  sides,  and  legs. — He  again  recovered  under 
similar  remedies,  but  in  November,  1818,  Avas  taken 
with  feverishness,  attended  with  a  parched  tongue 
and  mouth,  some  delirium  in  the  night,  and  further 
loss  of  flesh  and  of  strength,  and,  at  the  same  timc^ 
there  occurred  an  extensive  Ulceration  of  the  back 
part  of  the  Pharynx,  and  a  considerable  discharge  of 
bloody  mucus  from  the  Nostrils.  He  was  reduced 
from  lOst.  9lbs.  to  Ost.  Slbs.  This  state  continued^ 
and  Icterus  agaia  occurred,  with  the  usual  appear- 
ance of  the  tunica  albuginea,  skin,  urine  and  stools. 

156.  Soon  after  this  time  I  made  the  following  List 
of  appearances  and  affections  in  this  poor  sufferer^s 
complaint.  1.  Swarthiness  of  completion;  2,  fever- 
isliTfiQss,  with  parched  throat  and  mouth,  and  heat  of 
the  forehead  and  legs  ;  B.  tendency  to  perspiration  ; 
4.  quivering  of  the  chin  and  lips  in  speaking,  simi- 
lar to  that  observed  before  shedding  tears  ;  5.  tremor  ;- 
6.  fluttering  ;  7.  loss  of  flesh  ;  8.  discharge  of  bloody 
mucus  from  the  nostrils,  with  ulceration  ;  9.  iilcera- 
Hon  of  the  throat-;    10.  Icterus;    11.  discharge  of 


IN  A  CACHECTIC  FORM.  99 

much  blood  and  mucus ^  from  the  bowels,  preceded 
and  attended  by  pain  of  the  abdomen^  with  tenesmus 
and  forcing;  IS.  the  stools,  otherwise,  light-colour- 
ed;  i'^,  some  anasarca;  i^,  boils;  15,  2;ai7?/it2  ul- 
cers on  the  legs. 

157.  Again  on  the  use  of  similar  remedies,  these  ^ 
complaints  abated,  with  the  feverishness,  and  he  re- 
covered strength  and  a  good  appetite.  On  January 
27%  1819,  1  made  the  following  report.  The  Nos- 
trils  and  throat  are  nearly  free  from  ulceration.  The 
Icterus  has  disappeared.  The  appetite  is  improved, 
the  tongue  clean,  the  mouth  more  agreeable,  the 
bowels  regular,  the  stools  less  pale,  the  urine  pale  and 
clear.  He  is  improved  in  health,  strength  and  flesh, 
weighing  9st.  8lbs.  In  March  and  May  I  have  re- 
ported my  patient  getting  gradually  better  and  better, 
and  at  present  he  has  indeed  little  complaint.  He 
weighed  on  June  the  S8th,  1819;  list.  3lbs.  and  on 
August  the  2nd,  list.  7  ll^s. 


'Hi 


iOO  THE  MIMOSIS  ACUTA 


SECTIOX  m.  THE  CAUSES  AND  TREATMENT 


THE  TREATMENT  OP  THE  GENERAL 
AFFECTION. 


158.  The  most  general  cause  of  the  Mimosis 
Acuta  is  Sedentariness.  This  affection  is  there- 
fore frequently  observed  in  persons  of  studious  habits^ 
or,  of  sedentary  and  inactive  occupations  ;  it  has  oc- 
curred particularly  in  literary  persons,  in  persons  eu- 
gaged  in  the  sedentary  employments  of  the  lace-frame, 
the  stocking- frame,  the  tambour,  &c.  in  tailors,  and 
iu  women. 

159  Watching,  fatigue,  anxiety,  errors  in 
diet,  confined  and  impure  air,  and  want  of 
CLEANLINESS,  are  also  accessary  causes  of  the  Mi- 
mosis Acuta.  This  affection  has  sometimes  appeared 
to  have  been  immediately  induced  as  an  effect  of 
cold,  of  a  fit  of  intemperance,  of  indigestible  diet  just 
taken,  or  of  exposure  to  much  heat ;  it  has  been  par- 
ticularty  frequent  during  the  hot  summers  of  1818 
and  1819.  And  it  has  occurred  from  alarm,  or 
accident 

160.  The  treatment  of  the  Mimosis   Acuta  in  its 
simple  form,  embraces  the  administration  of  Emetic 


THE  TREATMENT.  101 

and  Purgative  Medicines,  a  particular  attention 
to  Diet,  Air,  Exercise,  Bathing  or  Sponging, 
AND  Sleep  and  great  caution  in  avoiding  the  Caus- 
es of  this  affection  just  enumerated.  On  each  of 
these  points  I  shall  make  a  few  observations. 

161.  In  the  severer  cases  an  Emetic  of  Ipecacuan 
has  appeared  highly  beneficial.  To  insure  its  early 
operation  plenty  of  weak  tepid  tea  may  be  taken  be- 
fore the  emetic  draught. 

iQ2,  The  Purgative  Medicines  which  I  have 
generally  employed  have  been  calomel,  the  pil.  hy- 
drarg.  rhubarb,  aloes,  senna,  the  sulphat  of  magnesia, 
and  pure  magnesia.  They  must  be  varied  according 
to  the  previous  state  of  the  bowels,  and  to  their  effect 
on  the  alvine  evacuation.  This  previous  condition  of 
the  bowels  is  a  state  of  Constipation,  of  Diarrhoea,  of 
Tenesmus,  or  of  Melsena,  §§  34,  1S6,  121. 

163.  In  the  case  of  Constipation  an  active  dose  of 
calomel  may  be  given,  and  if  its  effect  is  such  as  was 
desired,  it  may  be  repeated  at  first  every  fifth  night, 
and  afterwards  once  a  week,  or  once  in  ten  days,  al- 
ways insuring  its  operation,  if  necessary,  by  a  solution 
of  the  sulphat  of  magnesia  in  an  infusion  of  senna,  ov 
by  pills  of  aloes  and  rhubarb.  This  medicine  should 
also  be  repeated  on  the  intermediate  days.  The  object 
I  have  ever  had  in  view  has  been  to  avoid  purging, 
but  to  induce  a  large;  copious;  and  consistent 


lOS  THE  MIMOSIS  ACUTA. 

EVACUATION  DAILY ;  and  wheu  I  have  been  enabled 
to  effect  tbis;  I  have  considered  it  at  once- as  a  source 
and  criterion  of  increased  strength  or  health  of  the 
alimentary  canal.  Frequently,  however,  when  the 
patient  is  very  feeble  and  infirm,  the  medicine  appears 
to  accumulate  without  operation,  and  the  effect  on 
the  bowels  is  apt,  by  a  repetition  of  the  dose,  to  be 
violent ;  this  event  may  in  general  be  obviated,  ei- 
ther by  the  administration  of  a  proper  enema  at  the 
time  when  the  medicine  was  expected  to  move  the 
bowels,  or  by  inserting  into  the  rectum  a  suppository 
of  tuffy  or  inspissated  molasses,  or  of  soap  and  honey, 
and  other  similar  substance. 

164.  A  state  of  Diarrhoea,  with  scanty,  fcetid,  and 
dark-coloured  motions  is  by  no  means  uncommon. 
This  state  of  the  bowels  appears  to  me  to  have  yielded 
best  to  the  pil.  hydrarg.  given  every  thinl  or  fifth 
night,  and  a  dose  of  rhubarb  and  calcined  magnesia 
every  morning  or  twice  in  a  day.  And,  indeed,  in 
all  cases  where  the  more  active  purgative  medicines 
have  been  employed  in  the  commencement,  rhubarb 
appears  to  be  particularly  adapted,  from  its  tonic  pro- 
perties, to  complete  the  cure.  In  some  cases,  the  state 
of  diarrhoea  has  demanded  the  use  of  opium,  which  I 
have  then  generally  united  with  the  pil.  hydrarg, 
The  object  should  still  be  to  induce  copious  and 
SOLID  EVACUATIONS,  and  to  restore  them  to  their  nat- 
ural appearance,  form,  colour,  and  odour. 


THE  TREATMENT.  103 

165.  In  the  case  of  Tenesmus  a  small  opiate  ene- 
ma or  suppository  affords  almost  immediate  relief: 
the  purgative  medicine  must  of  course  be  given  at  the 
same  time,  and  in  this  case  the  oleum  ricini  has  a  de- 
cided advantage. 

166.  The  state  of  Melasna  is  generally  removed 
by  the  action  of  purgative  medicines  ;  the  pil.  hydrarg. 
and  calomel  have^  however,  appeared  to  be  particular- 
ly efficacious. 

167.  The  state  of  bowels  above  described^  must 
be  insured  until  the  patient  has  decidedly  recovered 
his  flesh  and  strength  ;  and  it  is  incumbent  to  explain 
to  him  the  indispensible  necessity  of  attending  to  this 
function  when  he  again  returns  to  his  usual  occupa- 
tions ;  for  this  complaint,  like  so  many  others,  is  par- 
ticularly liable  to  yield  imperfectly  only,  or  to  return 
from  a  repetition  of  its  causes.  In  the  more  continu- 
ed form  of  Mimosis  Acuta  this  attention  to  the  state 
of  the  bowels  is  still  more  necessary. 

168.  I  have  mentioned  the  approach,  in  form,  of 
some  cases  of  Mimosis  Acuta,  to  the  appearances  of 
Cachexia,  §  153  ;  in  these  and  similar  cases,  and,  in- 
deed, in  some  other  instances,  I  have  been  induced 
to  prescribe  the  sarsaparilla. 

169.  When  the  operation  of  purgative  medicine  in- 
duces weakness  or  faintness,  a  draught  with  the  tinct*. 


104  THE  MIMOSIS  ACUTA. 

opii,  or  tinct.  campliorsB  comp   and  the  sp.  ammoniEe 
aromat.  has  afforded  great  benefit. 

170.  It  appears  scarcely  necessary  to  make  any 
observations  respecting  the  absolute  necessity  of  an 
assiduous  attention  to  the  Diet  of  the  patient  affected 
>vith  the  Mimosis  Acuta ;  this  subject  is  of  acknowl- 
edged importance,  the  principles  of  dietetics  are  uni- 
versally known,  and  little  remains  but  to  enforce 
them  with  instance  and  assiduity.  The  meats  cannot 
be  too  simply  done.  Lean  beef  or  mutton,  and  fowl, 
are  the  most  unequivocally  good  ;  goose,  duck,  pork, 
veal,  and  even  lamb,  are  the  meats  most  cautiously  to 
be  avoided  ;  vegetables,  and  especially  the  uncooked 
vegetables,  are  also  injurious.  1  have  generally  re- 
commended a  slice  of  cold  beef  or  mutton,  or  a  little 
chicken,  to  breakfast,  instead  of  bread  or  toast ; — or 
biscuit,  if  meat  could  not  be  taken,  with  tea  or  coffee  : 
beef,  mutton,  or  chicken  to  dinner :  tea  Avith  biscuit 
in  the  afternoon  :  a  little  meat,  perhaps,  at  11  a.  m, 
and  at  supper.  I  have  stated  the  necessity  of  taking 
a  little  nutriment  frequently  ;  of  avoiding  to  load  the 
stomach;  and  of  supplying  the  place  of  the  evacuations 
daily  procured  from  the  bowels,  with  proper  nourish- 
ment. And,  indeed,  an  improvement  in  the  appetite 
is  generally  an  effect  of  cautiously  acting  upon  the 
alimentary  canal  by  purgatives. — To  these  articles  of 
diet  I  have  added,  after  the  bowels  have  been  evacu- 
ated several  times,  a  little  Ale,  and  I  believe,  with 
the  greatest  advantage.     Indeed  more  than    one  pa- 


/ 


THE  TREATMENT.  105 

tient,  ascribe  their  recovery  to  the  use  of  ale,  by  which 
their  strength  was  sustained,  and  they  were  enabled 
to  support  the  effect  of  the  purgative  medicines. —  I  he 
importance  of  an  attention  to  the  diet  is  sufficiently 
obvious  from  the  dreadful  effects  frequently  observed 
from  negligence  or  error  in  this  particular;  see  Case 
X.  8ome  complicated  cases  have  even  provetl  fatal 
apparently,  from  errors  of  this  nature. 

171.  The  effect  of  the  Country  Air,  and  of 
Gentle  Exercise  in  riding  or  travelling,  has  also 
been  extremely  marked  in  many  instances.  1  may 
refer  to  Case  iX,  as  an  exemplification  of  the  benefit 
resulting  from  a  journey  alone ;  and  a  similar  advan- 
tage has  been  much  more  remarkable  when  the  coun- 
try air  and  exercise  has  been  conjoined  with  proper 
remedies  and  diet. 

i^2.  Bathing  in  summer,  and  Sponging  the 
body  with  cold  water,  or  with  vinegar,  or  salt  and 
water,  in  the  other  seasons,  is  particularly  advanta- 
geous. After  bathing  or  sponging,  the  surface  is  to  be 
rubbed  wuth  a  coarshish  towel  until  a  glow  of  warmth 
is  felt  over  the  skin. 

173.  1  have  mentioned  Sleep  amongst  the  reme- 
dies of  the  Mimosis  Acuta.  In  cases  in  w^hich  wake- 
fulness and  restlessness  prevailed,  I  have  recommended 
an  anodyne  draught  with  the  tincture  of  opium,  or 
the  extract  of  hyosciamus,  at  bed  time.  But  in  other 
o 


106  THE  MIMOSIS  ACUTA. 

cases  I  have  endeavoured  to  procure  sleep  by  enjoin- 
ing the  patient  to  use  exercise  in  the  open  air,  to  bathe 
or  sponge,  immediately  afterwards  to  lie  down  on  a 
sofa  or  bed,  and  to  foment  the  feet  with  hot  water. 
The  following  plan  has  been  recommended  to  those  pa- 
tients whose  cases  seemed  to  require  it : — on  awaking 
in  the  morning  a  little  warm  tea  or  coffee  is  to  be  ta- 
ken, the  body  is  then  to  be  sponged,  and  the  breakfast 
finished  ;  the  patient  then  frequently  falls  asleep  ; — on 
awaking  he  is  to  rise,  dress,  and  ride  in  the  open  air, 
avoiding  fatigue  ; — on  returning  he  is  to  take  a  little 
nourishment  and  again  to  lie  down  to  sleep ; — on 
again  awaking,  he  is  to  dine,  and  afterwards,  to  ride 
once  more  in  the  open  air,  and  again,  on  returning, 
lie  down  for  a  time  : — the  body  is  again  to  be  spong- 
ed in  the  evening  on  going  to  bed.  In  this  manner 
the  weakness  is  often  soon  diminished  and  the  patient 
regains  his  flesh  and  general  health. 

174.  It  is  at  the  same  time,  of  the  utmost  moment 
to  avoid  the  causes  of  this  affection,  §§  158, 159,  and 
especially  anxiety  of  mind  and  fatigue  of  body. 


J 


THE  TREATMENT.  iO? 


II.    THE  TRATMENT  OF  THE  LOCAL 
AFFECTIONS. 


175.  In  addition  to  the  general  treatment  of  the 
Mimosis  Acuta,  its  complications  with  local  affection 
require  an  additional  and  particular  attention. 

176.  The  Affection  of  the  Head,  ^  79,  often  re- 
quires general  and  topical  bleeding,  and  blisters,  to- 
gether with  a  more  active  exhibition  of  purgative 
medicines  than  is  usually  adopted  in  the  uncomplicat- 
ed affection  ;  and  of  course  the  necessity  for  these  re- 
medies is  commensurate  with  the  degree  and  urgency 
of  the  local  affection.  If  there  is  slight  pain  or  ver- 
tigo, which  has  already  continued  some  time  without 
increasing  materially,  a  blister  applied  to  the  back  of 
the  neck,  with  leeches  to  the  temples,  and  active  pur- 
gatives, may  be  sufficient ;  but  if  the  accession  of  this 
complication  has  occurred  lately,  and  if  the  affection 
itself  be  severe,  with  much  dulness,  acute  pain,  or  au 
approach  to  stupor,  defective  vision,  &c.  the  lancet 
must  be  employed  freely,  cold  applications  be  made  to 
the  shaved  scalp,  cupping,  leeches,  blistering,  and  ac- 
tive purging  be  instantly  enforced,  and  abstinence 
and  the  erect  position,  as  far  as  possible,  enjoined. 

177.  The  Affection  of  the  Chest,  §  95,  frequently 
demands  the  application  of  blisters,  which  appear  par- 
ticularly useful  in  tlus  complication;  together  with 


i08  THE  MIMOSIS  ACUTA. 

the  addition  of  the  extr.  hyosciami,  or  opium,  to  the 
aperient  medicines.  It  is  in  this  complicated  affec- 
tion, often  mistaken  for  Phthisis  Pulmonalis,  that  tlie 
sponging  recommended  by  Dr.  Stewart*  seems  to  be 
HO  efficacious. 

178.  The  Paroxysm  of  Dyspnoea,  §  96,  is  relieved 
by  jether  and  other  similar  remedies  ;  but  it  is  remov- 
ed and  its  return  is  obviated  by  the  proper  remedies 
for  the  Mimosis  Acuta. 

179.  Fluttering  and  Palpitation  of  the  Heart, 
§  106,  and  Hiccough,  §  115,  are  each  relieved  a  little 
by  aether,  but  only  effectually  treated  by  the  remedies 
for  the  original  disorder. 

180.  la  the  Convulsive  and  Spasmodic  Affections, 
§  134,  it  may  be  necessary  sometimes  to  employ  the 
lancet,  but  in  general  a  course  of  purgatives,  and 
sometimes  an  emetic,  are  the  most  efficient  remedies. 

181.  Pain  in  the  course  of  the  Colon,  §§  30,  12S, 
is  usually  removed  by  the  operation  of  the  purga- 
tive medicines.  Friction  with  a  liniment  is  also  use- 
ful. And  if  necessary,  enemata  and  suppositories, 
should  be  administered.  Some  attention  is  due  to  the 
mode  of  applying  the  friction,  and  to  the  posture  of 
the  patient  after  the  exhibition  of  the  enema  or  sup- 
pository, when  the  pain  is  accompanied  with  tumor 

*  See  the  Edinb.  Med.  and  Surg.  Journal,  Vol.  9,  p.  356. 


THE  TREATMENT.  109 

suspected  to  arise  from  the  remora  of  hardened  fseces, 
§  ISS. 

±82,  The  treatment  of  the  cases  of  Constipation^ 
Diarrhoea,  Tenesmus,  Melaena,  and  Icterus,  has  al- 
ready been  noticed,  §§  164 — 166,  128. 

183.  In  the  Pains  of  the  Limbs,  §  34, 1  have  found 
an  anodyne  ammoniacal  liniment  to  afford  great  relief. 
This  affeetion  is  sufficiently  illustrated  by  Case  X. 
I  shall  only  remark  here  that  it  must  be  distinguished 
from  the  pain  of  the  shoulder  in  Affections  of  the 
Liver,  and  from  Rheumatism,  by  a  reference  to  the 
character  given,  §§  S4^,  &c. 


CHAPTER  II. 


THE  MIMOSIS  CHRONICA. 


SECTION  I.    THE  DESCRIPTION. 

184.  BY  the  term  Mimosis  Chronica,  it  is  intend- 
ed to  express  the  state  of  disorder  which  is  usually 
denominated  dyspepsia  and  hypochondriasis.  This 
form  of  Momosis  is  intimately  allied  to  the  less  severe 
and  more  continued  form  of  the  Mimosis  Acuta,  des- 
cribed §§  39 — 41,  from  which  it  may  originate,  or 
into  which  it  may  pass.  But  very  frequently  the 
Mimosis  Chronica  begins,  and  pursues  a  longer  or 
shorter  course,  with  the  character  about  to  be  given. 

185.  The  Mimosis  Chronica  is  denoted  in  general, 

by  FITS  OF  DESPONDENCY  AND  GLOOM,  OF  INVINCI- 
BLE DISINCLINATION  FOR  EXERTION,  OF  PAIN  ABOUT 
THE  HEAD,  SINKING  AT  THE  PR^CORDIA,  AND  HEAT 
OR    FULNESS    OF    THE  STOMACH. 

186.  The  countenance  is  liable  to  be  rather  sallow, 
and  occasionally  rather  pallid ;  and  there  is  often  a 
great  expression  of  despondency  and  lowness. 


THE  DESCRIPTION.  Ill 

187.  The  tongue  is  sometimes  affected  a  little,  as 
described  §>  2Q  ;  but  it  is  frequently  characterized  by 
a;  different  appearance  of  very  minute  white  grains  or 
points  ;  it  is  frequently  a  little  marked  by  the  teeth, 
and  sometimes  slightly  formed  into  sulci. 

188.  There  is,  in  general,  no  loss  of  flesh  ;  or  this 
is  at  the  commencement  only,  or  on  any  aggravation 
of  the  affection,  and  slight  in  degree.  And  there  is 
little  tremor  or  loss  of  strength. 

189.  The  patient  is  liable  to  be  affected  with  ver- 
tigo or  headach.  There  is  often  despondency  ;  a  feel- 
ing of  total  incapacity  for  exertion  in  business  or  soci- 
ety ;  an  impatience  and  irascibility  of  temper  ;  intoler- 
ance of  noise  or  disturbance ;  and  an  invincible  and 
overwhelming  state  of  inertia  or  listlessness.  There 
is  gaping,  and  sometimes  drowsiness.  These  affections 
occur  in  paroxysms  or  fits,  during  the  absence  of  which 
the  patient  is  more  himself,  but  manifests  a  constant 
disposition  to  speak  of  his  different  complaints  ^ 

190.  There  are  sometimes  irregularity  of  the  pulse, 
and  fluttering  and  irregularity  in  the  beating  of  the 
heart. 

191.  There  is  often  a  most  oppressive  feeling  of 
sinking  at  the  pit  of  the  stomach.  There  are,  at  dif- 
ferent times,  and  in  different  instances,  heartburn,  a 
sense  of  heat  or  burning,  acidity,  load,  distention,  in- 


US  THE  MIMOSIS  CHRONICA. 

flation,  nausea ;  sometimes  eructation  of  an  acid,  at 
other  times,  of  a  nidorous  taste,  and  sometimes  the 
rejection  of  fluid,  or  of  food.  The  bowels  are  often 
constipated,  or  there  are  unsatisfactory  evacuations, 
and  the  patient  feels  a  sense  of  load  about  the  rectum ; 
sometimes  there  is  considerable  pain  in  the  bowels. 
The  appetite  is  in  some  cases  moderate,  in  others  much 
impaired,  and,  with  the  digestion,  various  at  different 
periods  and  in  different  instances. 

193.  There  are  many  uneasy  feelings  iu  different 
parts  of  the  body,  which  vary  exceedingly,  but  always 
engross  the  patient's  attention  in  a  forcible  manner. 

193.  The  Mimosis  Chronica,  like  the  Mimosis 
Acuta,  is  liable  to  be  obscured  by  the  predominance 
of  some  particular  symptom.  But  it  docs  not  appear 
necessjiry  to  particularize  these  cases  after  the  ample 
detail  of  similar  complications  given  in  the  last 
chapter. 

194.  A  severe  form  of  this  affection  takes  place 
ia  Youths  from  an  indulgence  in  onanism.  It  is  at- 
tended with  the  dread  of  impotency,  and  involun- 
tary emissions  of  semen  during  the  night,  and  on  hav- 
ing an  alvine  evacuation.  There  are  palenees,  thin- 
ness, debility,  nervousness,  a  dreadful  state  of  des- 
pondency, indigestion,  disturbed  sleep,  palpitation  of 
the  heart,  &c. 


THE  DESCRIPTION.  113 


SECTION  II.    THE  DIAGNOSIS. 

19^«  The  Mimesis  Chronica  requires  to  be  dis- 
tinguished from  the  Miraosis  Acuta,  and  from  the  in- 
sidious approach  of  Obscure  Organic  Disease. 

196.  The  Mimosis  Chronica  borders  on  the  more 
continued  and  less  severe  form  of  the  Mimosis  Acuta^ 
described  §  39;  but  it  differs  materially  from  the 
more  severe  form  of  that  affection  characterized  §  2^» 
Notwithstanding  the  painful  and  distressing  disorder 
of  the  function  of  digestion,  nutrition  does  not  ap- 
pear to  be  materially  interrupted,  and  the  flesh  and 
strength  generally  remain  little  impaired,  or  if  a  lit- 
tle flesh  is  lost  at  one  period  of  the  affection  it  is 
regained  in  another,  or  the  case  is  stationary.  The 
Mimosis  Chronica  is,  indeed,  rather  characterized  by 

UNEASY    FEELINCS  tliaU  by   REAL    IMPEDIMENT    to  the 

functions.  The  mind,  temper,  and  spirits,  and  the 
corporal  and  functional  sensations  are  affected,  whilst 
there  is  in  reality  little  organic  change,  or  effect  in- 
duced in  the  process  of  assimilation.* 

197.  The  Mimosis  Chronica  is  distinguished  from 
Obscure  Organic  Disease  by  the  contrast  drawn, 
§  71  ?  to  which  may  be  added,  in  the  present  case,  tlie 
absence  of  loss  of  flesh,  the  early  and  constant  Di- 
agnostic of  the  latter  affection.* 

*  See  tlic  treatise  on  Diagstosis,  Tart  II,  §§  82,  182,  183. 
P 


114  THE  MIMOSIS  CHRONICA. 


SECTION  m.     THE  CAUSES  AND  TREATMENT. 

198.  The  Causes  and  Treatment  of  the  Mimosis 
Chronica  are  the  same,  mutatis  mutandis,  as  those  of 
the  Mimosis  Acuta  As  the  affection  is  of  longer  con- 
tinuance, a  more  persevering  use  of  the  pil.  bydrarg. 
and  of  gentle  purgatives  of  rhuharb  and  aloes  ;  and  a 
more  constant,  and  indeed  habitual  attention  to  diet 
with  geiitle  exercise  are  necessary. 

199.  In  this  disorder  the  patient  must  submit  to 
minister  to  himself  in  respect  to  the  particulars  just 
mentioned ;  for  nothing  less  than  this  will  afford  per- 
manent relief;  and  it  is  too  usual  for  patients  to  ex- 
pect from  medicine,  what  only  can  be  imparted  by 
proper  diet  and  exercise. 

200.  Ascidity  and  heartburn  may  be  relieved  by 
a  recourse  to  the  alkalis  and  the  calcined  magnesia. 
The  sp.  ammoniae  arom.  is  also  very  useful  in  these, 
and  in  other  distressing  feelings  attending  this  com- 
plaint. 

201.  The  load  after  eating  may  be  much  prevented, 
by  taking  warm  tea,  coffee,  or  negus. 

202.  Too  often,  however,  this  affection  is  protract- 
ed by  sedentary  habits,  and  cares  in  business  ;  or  it  is 
renewed  by  errors  in  diet  and  undue  exertion.     It  haa 


THE  TREATMENT.  115 

appeared  in  some  cases,  to  cease  spontaneously,  or  at 
least  after  medicine  had  been  abandoned. 

SOS.  The  first  object  ought  to  be  constantly  to  take 
nourishment  in  a  simple  form  and  small  bulk.  For 
this  purpose  lean  meat  is  the  best  adapted.  The  second 
object  should  be  to  induce  a  copious  alvine  evacuation 
daily,  by  means  of  the  remedies  above  mentioned,  and 
by  adopting  a  regular  habit  in  this  respect.  For  the 
latter  purpose  it  is  useful  to  repair  regularly  to  the 
water  closet  every  morning  within  a  few  minutes  after 
breakfast,  until  this  habit  be  acquired.  By  these  means 
this  distressing  complaint  may  be  mitigated,  shorten* 
ed,  and  perhaps  altogether  removed. 


CHAPTER  III. 

THE  MIMOSIS  DECOtOR. 


SECTION  I.    DESCRIPTION  WITH  CASES. 

SOI.  THE  form  of  Mimosis  of  which  an  account 
is  now  to  be  attempted,  and  to  which  I  have  appro- 
priated the  denomination  of  Mimosis  Decolor,  appears 
to  have  been  very  inadequately  described  by  medical 
writers  under  the  appellation  of  chlorosis,  which  is 
only  ONE  of  the  forms  of  this  affection.  I  shall,  there- 
fore, bestow  great  pains  to  place  before  my  reader  the 
characteristics  of  the  different  varieties,  simple  and 
complicated,  of  this  affection, 

205,  And,  first,  I  take  this  early  occasion  of  stat- 
ing, that  the  Mimosis  Decolor  occurs  principally  in 
Female  Youth  ;  but  frequently  in  Married  Wo- 
men, both  young  and  old ;  and  occasionally  in  the 
young  and  sedentrry  of  the  Male  Sex,  and  even  in 
men  of  adult  age,  from  the  influence  of  sedentary  hab- 
its and  mental  anxiety. 

206.  There  are  two  forms  of  the  Mimosis  Decolor, 
of  which  the  first  is  more  acute^  and  the  second,  more 


DESCRIPTION,  WITH  CASES.  ,      117 

chronic  and  protracted.  But  there  is  every  interme- 
diate shade,  and  frequently,  the  transition  of  one  of 
these  forms  into  the  other.  The  Mimosis  Acuta,  also 
occasionally  assumes  or  conjoins,  by  an  insensible  gra- 
dation, the  form  of  the  Mimosis  Decolor. 

207.  The  more  acute  form  of  the  Mimosis  Decolor 
may  be  described  as  observing  three  different  stages, 
— the  Incipient,  the  Confirmed,  and  the  Inveterate. 
It  may  be  characterized  in  general  as  uniting  a  mor- 
bid Sl'ATE  OF  THE  COMPLEXION,  AND  GENERALLY 
OF  THE  SURFACE,  WITH  RECURRENT  PAIN  OF  THE 
HEAD,  AND  OF  THE  SIDE,  PALPITATION  OF  THB 
HEART,  FLUTTERING,  AND  NERVOUSNESS,  AND  SOME 
TENDENCY  TO  LOSS  01*'  FLESH,    AND    TO    CEDEMA. 


The  Incipient  Stage  of  the  more  acute  form 
of  the  Mimosis  Decolor  is  denoted  by  paleness  of  the 
complexion,  an  exanguious  state  of  the  prolabia,  and 
a  slight  appearance  of  tumidity  of  the  countenance, 
and  puffiuess  of  the  eye-lids,  especially  the  upper  one. 
TherQ  is  sometimes  a  tinge  of  green,  or  yellow,  or  of 
lead  colour,  and  frequently  darkness  of  the  eye-lids. 

S09.  There  are  great  paleness  of  the  general  sur- 
face, hands,  fingers,  and  nails ;  an  opaque,  white,  tu- 
mid, and  flabby  state  of  the  skin  5  and  a  tendency  to 
eedema  of  the  calves  and  ankles.  And  there  is  a  cer- 
tain loss  of  flesh. 


118  THE  MIMOSiS  DECOLOR. 

SIO.  The  tongue  is  white^  and  loaded  ;  it  is  swol- 
len, marked  by  pressure  against  the  teeth,  or  variously 
formed  into  creases  or  folds  ;  its  papillse  are  very  nu- 
merous and  much  enlarged.  The  gums  and  the  inside 
of  the  cheeks  become  tumid,  and  the  latter  as  well  as 
the  former,  are  sometimes  impressed  by  the  teeth. 
The  breath  is  tainted,, 

211.  The  patient  is  generally  languid,  listless,  se- 
dentary, indisposed  for  exertion,  easily  overcome  by 
exercise,  nervous,  and  low-spirited,  drowsy,  *  dizzy, 
fainty,  or  breathless.  There  is  generally  severe  head- 
ach  or  vertigo ;  the  memory  and  power  of  attention 
are  apt  to  be  impaired  5  and  there  is  sometimes  lieavi- 
ness  for  sleep. 

SIS.  There  is,  in  difiPerent  instances,  pain  of  one 
or  both  sides  about  the  false  ribs,  or  in  the  hypochon- 
driac or  chondiliac  regions.  Sometimes  there  is  cough, 
difficulty  in  breathing,  palpitation  or  irregular  action 
of  the  heart,  or  imperfect  syncope,  and  almost  univer- 
sally a  sense  of  fluttering  about  the  prjecordia. 

213.  The  appetite  is  generally  impaired.  There 
is  frequently  a  morbid  appetite  for  acids,  or  for  mag- 
nesia. The  bowels  are  constipated,  a  state  which 
sometimes  leads  to  diarrhoea.  The  faeces  are  dark-co- 
loured, foetid;  and  scanty.  The  urine  is  frequently 
loaded. 


DESCRIPTION,  WITH  CASES.  119 

514.  The  catamenia  become  irregular^  are  preced- 
ed and  attended  by  much  pain  of  the  back  and  re- 
gion of  the  uieius,  and  sometimes,  but  not  always, 
become  slowly  defective  in  quantity,  and  pale  in 
colour. 

51 5.  In  the  Confirmed  Stage  of  this  affection  the 
state  of  the  complexion  and  general  surface  is  still 
more  marked.  The  countenance  is  still  more  pallid, 
the  prolabia  and  the  gums  exanguious,  or  the  prola- 
bia,  especially  the  upper  one,  have  a  slight  lilac  hue, 
and  the  integuments  are  tumid. 

216.  The  skin  is  smooth,  but  becomes  preternatu- 
rally  dry.  The  integuments  are  puffy,  opaque,  and 
pale,  or  yellowish,  and  there  is  a  tendency  to  cedema 
of  the  feet.  There  is  frequently  scarcely  any  further 
loss  of  flesh. 

217.  The  tongue  becomes  clean  and  smooth.  But 
it  is  pale,  with  a  slight  but  peculiar  appearance  of 
transparency,  and  of  a  pale  lilac  hue.  And  it  remains 
a  little  swollen  and  indented. 

318,  The  patient  is  affected  with  langaior,  lassi- 
tude, and  even  serious  weakness,  being  at  once  reluc- 
tant and  unable  to  undergo  fatigue. 

219.  There  are  ojTten  attacks  of  severe  pain  of  the 
Jiead,  or  of  equally  severe  pain  of  the  side,  and  re-^ 
peated  bleeding,  leeches,  and  blisters  are  usually  em' 


120  THE  MIMOSIS  DECOLOR. 

ployed,  affording  a  temporary  respite  from  these 
complaints.  There  are  also,  sometimes,  fits  of  dys- 
pnoea, of  palpitation  of  the  heart,  or  of  fainting,  with 
beating  of  the  carotids, 

S20.  The  pulse  is  rather  frequent,  often  about  100, 
and  easily  accelerated  and  rendered  irregular  by  men- 
tal emotion. 

221.  The  appetite  is  sometimes  impaired,  occa- 
sionally greater  than  natural,  and  very  frequently 
depraved,  inducing  a  longing  or  constant  desire  for 
some  indigestible  substance,  as  acids  or  pickles,  mag- 
nesia, chalk,  cinders,  sand,  coffee  grounds,  tea  leaves, 
flour,  grits,  wheat,  &c.  which  the  patient  likes  to 
have  constantly  in  her  mouth,  or  to  which  recourse  is 
had  when  she  suffers  from  agitation  of  mind.*  The 
bowels  are  slow  and  constipated,  a  state  which  some- 
times alternates  with  diarrhoea,  and  induces  melsena ; 
the  stools  are  dark,  foetid,  and  scanty. 

222.  The  catamenia  are  attended  with  pain,  and 
become  paler,  and  less  in  quantity,  often  cease,  and 
often  yield  to  a  state  of  leucorrhoea  which  is  more  or 
less  constant. 

223.  In  the  Inveterate  Stage  of  the  Mimosis  De- 
color all  the  symptoms  assume  an  aggravated  charac- 

*  In  the  West  Indies  an  aflFection  similar  to  the  present  seeras  to  prevail  amongst 
the  Negroes,  who  are  then  termed  Dirt-e»ters. 


i 


Description,  with  cases.  is4 

ter.  There  is  a  very  slow  but  progressive  loss  of  flesh. 
The  languor  becomes  a  state  of  permanent  debility w 
The  oedema  increases  and  takes  on  the  aggravated 
form  of  anasarca.  '1  he  pulse  becomes  frequent.  There 
are  less  of  the  appearances  of  mere  disorder,  and  more 
of  the  character  of  disease^  §  71*  Or  those  local  af- 
fections which  existed  in  a  less  continued  manner  be-- 
fore,  now  became  either  permanent,  or  are  induced 
by  the  slightest  causes,  and  the  patient  can  scarcely 
bear  the  most  ordinary  occurrences  of  domestic  life, 
and  perhaps  remains  always  in  bed.  Sometimes  there 
is*an  almost  permanent  pain  of  the  head,  perhaps  with 
intolerance  of  light  or  of  noise.  Sometimes  there  is 
pain  of  the  chest,  with  tenderness,  difficulty  in  breath- 
ing, and  cough.  Frequently  there  are  pain  and  ten- 
derness of  the  abdomen,  with  sickness  and  constipa- 
tion, or  with  diarrhoea.  Different  symptoms  reigu 
in  different  instances,— as  some  hysteric  or  spasmodic 
affection  5  a  state  of  locked  jaw,  closed  hand,  contract- 
ed foot,  or  twisted  limbs ;  palpitation  of  the  heart ; 
hurried,  or  suspended  respiration  ;  long  fits  of  cough- 
ing 5  hiccough  5  retention  of  urine. 

SS4.  Besides  the  form  of  the  Mimosis  Decolor  ia 
its  more  acute  form,  just  described,  there  are  some 
varieties  which  require  to  be  distinctly  noticed  :  — 

22o.  1.  Sometimes  there  is  less  pallor  of  the  coun- 
tenance and  prolabia,  but  a  rin^  of  tumid  darkness 
round  the  eye,  and  perhaps  a  tumid  state  of  the  upper 


iJ88  Tlffi  ISIIMOSrS  DECOLOR. 

lip.  2.  Sometimes  the  complea^ion  is  of  a  more  yellow 
or  icierode  hue,  3.  Sometimes  the  complexion  is  of  a 
peculiar  lead -colour.  4.  Frequently  there  is  a  mixture 
of  the  state  of  the  complexion  observed  in  the  Mimo- 
sis  Acuta,  with  one  or  other  of  those  observed  in  the 
Miniosis  Decolor.  5.  There  is  sometimes  a  peculiar 
state  of  coldness^  cold  moisture,  and  lividity  of  the 
hands  and  fingers,  and  a  lilac  hue  of  the  nails,  the 
tips  of  which  often  become  white  and  opaque.  6.  The 
state  of  Mimosis  Decolor,  consequent  on  haemorrhagy, 

also  deserves  to  be  distinctly  noticed  ;  there  are  pale- 

* 

ncss  and  slight  yellowness  of  the  complexion,  exan- 
guious  prolabia,  a  greater  degree  of  loss  of  flesh,  and 
great  fluttering  and  nervousness. 

226.  Such  are  the  usual  symptoms  of  the  different 
stages  of  the  Mimosis  Decolor.  But,  as  in  the  Mimo- 
sis Acuta,  some  of  these  symptoms  are  liable  to  be 
much  aggravated,  and  to  assume  the  form  of  serious 
Local  Disease,  the  following  list  of  these  complica- 
tions possess  therefore  great  interest : — 

1.  PAIN  OF  THE  HEAD. 

2.  COUGH  AND  DYSPNOEA. 

3.  PALPITATION  OF  THE  HEART. 

4.  PAIN  AND  TENDERNESS  OF  THE  SIDE. 

5.  PAIN  AND  TENDERNESS  OF  THE  ABDOMEN. 

6.  CONSTIPATION. 

7.  DIARRHOEA. 

8.  MELAENA. 

9.  MENORRHAGIA.  .  .  ." 
10.   TENDENCY    TO    HAEMORRHAGY. 


''       DESCRIPTION,  WITH  CASES.  i^^ 

11.  PURPURA. 

12.  LEUCORRHOEA. 

13.  HYSTERIC    AFFECTIONS. 

14.  OEDEMA ANASARCA. 

SS7.  These  compile  ations  with  the  Mimosis  De- 
color must  be  distinguished  from  a  different  set  of 
diseases  from  those  noticed  in  the  first  chapter.  The 
complications  with  the  Mimosis  Acuta  require^  in  gen- 
eral, to  be  discriminated  from  acute,  those  with  the 
Mimosis  Decolor  must  be  distinguished  from  sudden 
or  from  insidious,  local  affections.  These  distinctions 
will  be  attempted  in  the  ensuing  section.  There  is 
also  great  danger,  in  the  complications  with  the  Mi- 
mosis Decolor,  as  in  those  of  the  Mimosis  Acuta,  of 
Ahe  transition  into  organic  affection. 

S2S.  There  is  in  many  cases  a  remarkable  state 
apparently  of  tlie  capillary  system,  giving  rise  to  a 
hsemorrhagic  tendency, — to  epistaxis,  melsena,  hieraa- 
temesis,  menorrhagia,  and  even  purpura.  In  cases  of 
the  Mimosis  Decolor,  the  blood  discliarged  from  the 
nose,  or  taken  from  the  arm,  and  tlie  catamenia,  fre- 
quently become  almost  aqueous  and  colourless,  so  that 
this  affection  presents  an  instance  in  which  the  vital 
fluid  undergoes  considerable  change.  1  have  seen 
the  blood  scarcely  tinge  the  sheets,  and  I  have  seen  it 
resolve  itself  almost  entirely  into  serum  with  scarcely 
any  crassamentum.  Bo  inadequate  "  to  the  subject, 
ure  all  the  theories  of  this  extraci^dinary  affection  ! 


124  THE  MIMOSIS  DECOLOR. 

239.  In  the  more  chronic  form  of  the  Mimosis 
Decolor,  there  is  a  continued  though  variable  state  of 
sallowness,  of  yellowness  or  icterode  hue,  of  darkness^ 
or  of  a  wan  squalid^  or  sordid  paleness  of  complexion ^ 
or  a  ring  of  darkness  surrounding  the  eyes,  and  ex- 
tending a  little  perhaps,  towards  the  temples,  and 
cheeks,  and  sometimes  encircttng  the  mouth,  without 
tumidity,  without  the  pallidness  of  the  prolabia  men- 
tioned §  S08  ;  and  without  much  tendency  to  oedema. 

S30.  The  general  surface  is  more  or  less  affected. 
And  in  the  severer  and  more  continued  cases,  there 
is  frequently  a  peculiar  deformity  of  the  nails,  which 
fall  in  irregularly  in  their  middle  part,  become  brittle^ 
and  break  off  in  laminse,  so  that  the  patient  is  almost 
imable  to  take  a  pin  out  of  her  dress.  There  is  less 
pudency  to  oedema  in  this,  than  in  the  more  acute 
form  of  the  Mimosis  Decolor, 

231.  The  state  of  the  tongue  is  various, — gener- 
ally but  slightly  loaded,  or  perfectly  clean  and  moist, 
—  sometimes  of  a  light  green,  light  lilac,  or  bright  red 
colour, — smooth  and  clean  with  enlarged  papillae, — 
formed  into  creases, — or  into  lobules,  or  other  forms, 
— somewhat  swollen  in  general,  and  slightly  marked 
by  the  teeth. 

232.  There  is  evidently  a  state  of  general  weak- 
Bess  and  indisposition.  The  patient  suffers  from  pain 
of  the  head,  continued,  or  in  paroxysms,  and  from 


DESCRIPTION,  WITH  CASES.  1S5 

pain  of  the  right  or  left  side  ia  the  hypochondriac, 
chondiliac^  or  iliac  regions  ;  she  is  liable  to  vertigo  on 
stooping,  to  fluttering  on  being  startled,  and  to  pal- 
pitation of  the  heart;  the  respiration  often  appears 
short,  and  the  patient  seems  out  of  breath  ;  sometimes 
there  is  paleness  with  the  appearance  of  faintness. 

533.  The  appetite  varies,  ^he  bowels  are  affect- 
ed with  alternate  constipation  and  diarrhoea.  In  the 
afternoon  there  is  often  flatulent  distention  of  the  ab- 
domen, which  often  obliges  the  patient  to  unlace  her 
stays  5  or  long  continued  rumbling  or  borborigmus. 

534.  The  catamenia  are  regular  in  their  periods 
perhaps,  but  often  irregular  in  their  flow,  paler  and 
more  scanty  than  natural,  and  there  is  often  leu- 
corrhoea, 

235.  The  Mimosis  Decolor,  in  all  its  varieties,  is 
particularly  characterized  by  being  changeable,  liable 
to  exacerbations  in  itself  and  in  its  complications,  and 
to  the  recurrency  of  its  symptoms  even  during  a  gen- 
eral amendment.  Repeated  bleeding  and  blis- 
ters have,  in  general,  been  employed  for  the  affec- 
tion of  the  head,  or  of  the  side,  a  circumstance  which 
becomes  a  deplorable  characteristic  of  this  affection. 

236.  In  those  females  wlu)  have  been  married  and 
who  have  had  a  family,  the  complexion  has  frequent- 
ly, but  by  no  means  always,  been  icterode ;  in  one 


156  THE  MIMOSIS  DECOLOR. 

case  the  coantcuauce  was  pale  and  cxanguious,  in  an- 
other, wan  and  squalid,  and  in  a  third,  there  was  much 
colour,  with  a  ring  of  deep  darkness  round  the  eyes. 
The  affection  differs  in  no  essential  particular  from 
that  of  younger  and  unmarried  females ;  nor  does  it 
at  all  appear  to  impede  conception. 

237.  In  the  Mimesis  Decolor  I  have  observed  an 
eruption  of  urticaria,  in  very  large,  elevated  wheals, 
sometimes  solitary,  and  sometimes  in  considerable 
number. 

S38.  I  shall  now  proceed  to  exemplify  the  des- 
cription of  the  Mimesis  Decolor,  by  a  series  of  cases 
taken  succinctly  in  the  presence  of  the  patients  them- 
selves : — 

339.  Case  LI.  Miss  F.  aged  S3,  of  delicate 
and  sedentary  habits.  She  was  observed  first  to  lose 
Ler  colour  and  appearance  of  good  health,  several 
months  ago.  During  this  interval  the  countenance, 
— cheeks  and  lips, — the  fingers,  nails,  and  general 
^drfiice,  have  become  pale  and  exanguious,  and  there 
is  a  degree  of  puffiness  of  the  integuments,  aad  of 
cedematous  swelling  of  the  ankles.  The  tongue  is 
white,  loaded,  and  impressed  somewhat  by  the  teeth. 
There  are  headach,  and  pain  of  the  sides  alternately, 
vertigo,  fluttering  about  the  heart,  listlessness  and 
sense  of  fatigue  from  the  slightest  exertion,  which  has 
seemed  to  aggravate  all  her  complaints  indeed, — con- 


( 


DESCRIPTION,  WITH  CASES.  1^7 

stipation  and  painful  menstruation. — An  attack  of  vi- 
olent pain  and  throbbing  of  the  head,  with  intolerance 
of  light,  noise,  or  disturbance,  and  great  nervousness, 
lias  been  quite  removed,  and  the  other  symptoms  much 
mitigated,  by  purgative  medicines  after  copious  bleed- 
ing had  failed  of  inducing  relief.  The  amendment 
in  general  appearance  is  also  rapidly  progressive. 

S40.  Case  LIL     S.  G.  aged  I7.     She  has  been 
long  employed  at  the  lace  frame.     The  bowels  have 
generally  been   slow.      The  catamenia  began  to  ap- 
pear two  years  ago.      Three  months  since  she  began 
to  complain  of  acute  and  continued  pain  of  the  right 
side  of  the  head ;  she  was  observed  to  lose  her  colour 
to  become  weak,  and  to  be  easily  overcome  and  ren- 
dered breathless  by  exercise. — xlt  present  the  counte- 
nance is  extremely  pale,  and  a  little  tumid  :  the  prola- 
bia  and  gums  are  exanguious.    The  tongue  is  swollen 
not  much  indented,  but  formed  into  folds  and  plaits,, 
perfectly   clean,    with    enlargement    of  its   papillse. 
The  hands  and  general  surface  are  pale.     She  has  lost 
flesh  considerably.     She  complains  much  of  the  pain 
of  her  head,  which  is  always  aggravated  on  walking 
out.     There  is  no  dyspnoea  or  cough.      The  pulse  i» 
96.     The  appetite  is  impaired,  with  a  great  desire  for- 
acids.      The  bowels  are  not  costive  just  now.     The 
catamenia  are  regular,  but  have  been  paler  than  nat- 
ural at  the  two  last  periods. — This  patient  recovered 
rapidly  from  the  use  of  purgative  medicine.      The 
perfect  cure  was,  however,  impeded  by  the  necessity  . 


laS  THE  MiMOSIS  DECOLOR. 

of  still  sitting  much  at  the  lace-frame,  and  so  contiii-» 
uing  the  baneful  operation  of  the  cause  of  her  com- 
plaints, an  occurrence  too  frequent  amongst  this  class 
of  patients. 

341.  Case  LIII.  M.  J.  aged  20,  housemaid* 
April  1st,  1818.  She  became  indisposed  nine  months 
ago,  from  headach,  sickness,  and  general  feebleness. 
Her  complaints  increased  gradually  until  Christmas 
1817,  when  she  became  more  seriously  ill,  and  was 
placed  under  the  care  of  an  eminent  surgeon,  who 
stated  her  disorder  to  be  a  Disease  of  the  Liver.  She 
t?as  bled,  and  took  saline  medicines  ;  but  her  com- 
plaints augmented.  About  this  period  she  consulted 
me,  and  I  made  the  following  statement  of  the  symp- 
toms : — The  face  in  general,  and  the  lips  and  gums, 
are  extremely  pale  and  exanguious  ;  the  eye-lids  are 
swollen  and  puffy, — ^a  circumstance  most  observed  ear- 
ly in  the  morning,  and  then  both  in  the  eye-lids  and 
lips.  The  hands  are  exceedingly  pale  and  colourless  ; 
the  skin  in  general  is  dry  and  rough,  aud  ever  free 
from  perspiration  even  when  she  takes  exercise  ;  the 
hands  and  feet  are  apt  to  be  cold.  The  ankles  are 
affected  with  oedema,  especially  at  night,  but  even  in 
tike  morning  she  can  scarcely  put  on  her  shoes.  The 
tongue  is  exanguious,  of  a  pale  lilao  colour,  semi-trans- 
parent,  smooth,  clean  and  moist.  She  does  not  com- 
plain much  of  weakness.  She  has  much  pain  and 
beating  across  the  forehead,  with  a  sense  of  weight  in 
the  eyes,  and  sometimes  vertigo, — all  of  which  symp- 


bESCRIPTION,  WITH  CASES.  1S9 

toms  are  especially  experienced  on  walking  about, 
and  from  noise,  felie  has  much  palpitation  of  tlie  heart, 
accompanying  the  pain  of  the  head,  and  accompanied 
by  pain  of  the  hypochondria.  She  is  easily  hurried, 
and  her  complaints  are  then  always  reproduced  if  pre- 
viously absent,  or  aggravated  if  present.  The  bowels 
are  habitually  costive.  The  catamenia  are  irregular, 
appearing  often  only  after  an  interval  of  nine  weeks, 
and  preceded,  for  some  days,  by  drowsiness  and  much 
pain  of  the  loins  and  in  the  hypogastric  region.  She 
has  been  affected  for  four  Oi*  five  months  with  leueorr- 
hosa ;  this  ceases  before  the  appearance  of  the  catame- 
nia, which  gradually  resume  the  appearance  of  leucorr- 
hoea. — Since  the  day  she  consulted  me,  she  has  per- 
severed in  a  course  of  purgative  medicine,  consisting 
of  aloes  and  rhubarb,  with  daily  exercise,  light  meat 
diet,  and  a  little  ale.  Bhe  has  now  a  natural  com- 
plexion, a  return  of  colour,  a  healtliy  appearance  o€ 
the  prolabia,  gums,  and  tongue,  and  all  her  com- 
plaints have  ceased  with  the  exception  of  occasional 
headach. — October  22.  This  patient  continues  well ; 
but  still  finds  her  purgative  pills  requisite. — The  sis- 
ter of  M.  J.  has  lately  suffered  from  a  slight  attack 
of  this  affection. 

242.  Case  LIV.  Miss  L.  aged  25.  May  18, 1819. 
She  began  to  be  indisposed  three  or  four  years  ago. 
She  at  first  lost  her  colour  and  some  flesh  ;  lately  she 
has  lost  little  flesh,  but  has  become  very  pale.  She 
has  complained  at  different  periods  of  pain  of   the 


130  THE  MIINIOSIS  DECOLOR. 

head, — aud  of  both  sides^  and  her  complaint  ha* 
l>eea  considered  Infiammation  of  the  Lmigs,  aud  an 
•Affection  of  the  Liver  She  has  also  suffered  from 
llutteriug  aud  palpitation,  breathlcssness,  nervousness, 
aud  faiulishuess.  Her  appetite  has  been  impaired, 
she  has  experienced  distention  of  the  abdomen,  oblig- 
her  to  unlace,  and  has  had  much  ilatus.  She  has 
often  violent  hiccough.  The  bowels  have  been  prone  to 
costiveness.  At  present  the  countenance  and  prolabia 
ace  pale ;  the  complexion  is  apt  however  to  be  yel- 
lowish, and  once  she  was  atated  to  have  had  Icterus. 
The  tongue,  gums,  and  inside  of  the  lips  are  pale ;  the 
tongue  is  clean  but  a  little  creased  and  with  enlarged 
piipill».  The  hands,  fingers  and  nails  are  palish ; 
the  skin  rather  opaque  and  dry.  There  have  been 
attacks  of  pain  of  the  right  side  of  the  liead,  generally 
ascribed  to  the  application  of  leeches  to  the  side. 
There  have  been  more  severe  attacks  of  pain  at  the 
pit  of  the  stomach,  of  the  left  side  over  the  false  ribs, 
and  of  the  mammae^  The  palpitation  and  breathless- 
ness  are  induced  on  any  hurry,  or  on  w^alking  quick. 
The  pulse  is  usually  108.  The  hiccough  is  not  ascrib- 
ed to  any  particular  cause.  There  is  some  degree  of 
swelling  of  the  calves  and  insteps.  The  urine  often 
deposits  a  copious  sediment  of  light  pink.  The  cata- 
menia  have  become  irregular,  pale,  scanty, — and  ar& 
succeeded  by  fluor  albus. — May  1820.  Miss  L.  has 
quite  recovered  under  a  plan  of  purgative  medicine, 
and  at  present  appears  and  feels  in  perfect  health. 


DESCRIPTION,  WITH  CASES.  iU 

S43.  The  three  following  cases  exemplify  the  first 
and  fifth  variety  of  the  Mimosis  Decolor  alluded  to 

»44.  Case  LV.  Miss  B.  S.  of  B.  aged  19. 
December  8th,  1816.  This  young  lady  has  been 
slightly  indisposed  for  several  years,  complaining  of 
languor  and  indisposition  for  moving  about.  Two 
days  ago  the  ankles  became  affected  with  considerable 
cedema,  Avhich  has  excited  alarm.  There  is  occasion- 
ally an  obvious  saliowness  and  darkness  of  the  com- 
plexion, not  very  observable  at  this  moment.  The 
tongue  is  white,  doughy,  and  impressed  with  the  teeth, 
and  the  papillae  are  prominent.  The  hands  and  fin- 
gers are  affected  with  a  little  tumidity,  and  with  a  cool 
clammy  moisture ;  they  are  rather  dark  coloured,  and 
the  nails  are  a  little  livid.  She  is  rather  heavy  fo^* 
sleep ;  there  is  a  little  want  of  mental  energy.  There 
is  little  or  no  headach,  palpitation,  or  pain  of  the  side, 
but  sometimes  hurry  in  the  breathing.  The  bowels 
are  habitually  costive.  The  abdomen  often  tumid. 
The  catamenia  are  regular. — This  patient  recovered 
slowly,  but  completely,  from  the  use  of  purgative  me- 
dicines, a  journey,  and  continued  exercise,  with  ii 
strict  attention  to  diet. 

M5,  Case  LVI.  Miss  P.  of  G,  aged  19.  De- 
cember yth,  1816.  hhe  has  been  indisposed  for  a  very 
considerable  period.  The  countenance  is  palish  ;  there 
is  a  ring  of  darkness  about  the  eyes  and  mouth  f  the 


13^  THE  MIMOSIS  DECOLOR. 

lips  are  higli  coloured ;  the  complexion  varies^  becom- 
ing much  sallower  at  times.  The  tongue  is  loaded, 
white,  pastjj  impressed  with  the  teeth,  and  displays 
elongated  papillae.  She  is  listless  and  sedentary^  and 
easily  fatigued.  There  is  some  loss  of  flesh.  The 
hands  are  apt  to  be  cold,  clammy,  and  deep  coloured, 
with  a  trifling  blueness  of  the  nails  ;  the  feet  are  also 
apt  to  be  cold.  There  is  occasionally  headach.  She 
has  suffered  much  from  pain  of  the  left  side  over  the 
false  ribs,  for  which  fifteen  blisters  have  been  applied 
at  different  intervals.  She  has  suffered  from  a  severe 
cough,  which  has  occurred  in  violent  fits,  and  which 
lias  been  generally  relieved  by  inhaling  the  vapour  of 
]iot  water.  Tliere  have  been  irregular  palpitation  of 
the  heart,  and  irregularity  in  the  frequency  of  the 
pulse,  so  as  to  induce  a  suspicion  of  Organic  Disease 
of  the  Heart;  but  she  runs  up  stairs  with  rapidity 
and  without  unusual  distress,  and  she  generally  walks 
quick.  The  bowels  have  required  opening  medicine. 
The  catamcnia  are  natural. — A  nearly  similar  report 
was  made  on  January  the  9th,  I8I7.  The  pain  of  the 
side  and  chest  had  varied  its  seat  and  severity  repeat- 
edly. Exposure  to  the  frosty  air  had  induced  a  vio- 
lent fit  of  coughing.  The  other  symptoms  were  nearly 
as  before. — This  patient  recovered  slowly. 

246.  Case  LYII.  Miss  M.  G.  aged  18.  Novem- 
ber S7j  18 17. — She  was  affected  with  scarlatina  near- 
ly two  years  ago,  and  thinks  she  has  never  been  per- 
fectly well  since  that  time.     Ijately  she  has  been  ob- 


DESCRIPTION,  WITH  CASES.  1S3 

served  to  change  colour  and  to  become  occasionally  pale 
and  sallow ;  she  has  become  nervous  ;  and  she  has  been 
subject  to  variable^  recurrent  pain  of  the  stomach,  and 
of  each  side  in  the  chondiliac  regions.  At  present 
the  countenance  is  pale  in  general ;  the  lips  are  of  a 
deep  red  colour ;  the  eye  lids  are  occupied  by  an  ex- 
tensive ring  of  blackness.  The  tongue  is  white,  but 
with  very  lew  red  points,  and  with  little  swelling  or 
indentation.  The  breath  is  sometimes  tainted.  81ie 
has  lately  felt  much  indisposed  to  exertion.  The 
hands  are  generally  cold  and  clammy,  the  nails  are 
of  a  light  blue  or  lilac  hue,  and  their  tips  are  white 
and  opaque.  The  memory  of  recent  events  is  said  to 
be  much  impaired,  but  not  that  of  more  remote  ones  ; 
she  reads,  however,  and  remembers  what  is  read  bet- 
ter than  events,  tthe  is  liable  to  pain  of  the  occiput 
and  in  two  points  on  the  forehead,  the  latter  being  of 
a  beating  kind  5  to  pain  of  the  stomach  of  a  wearisome 
nature  ;  and  to  pain  of  the  two  chondiliac  regions  in  a 
more  acute  and  less  continued  form.  These  pains 
come  and  go  without  manifest  cause,  and  rather  sud- 
denly. They  are  all,  however,  most  apt  to  be  induc- 
ed by  any  thing  which  hurries  and  affects  the  mind. 
There  is  no  cough.  She  is  much  liable  to  attacks  of 
fluttering  about  the  heart,  especially  on  any  recur- 
rence of  distress  or  mental  affection.  Her  appetite  is 
impaired  :  she  is  particularly  fond  of  picJdes,  and  of 
cold  esculent  vegetables  uncooked  from  the  garden ; 
some  things  are  disliked,  as  pudding.  There  is  occa- 
sionally a  difficulty  of  making  water.     The  bowels 


134  THE  MIMOSIS  DECOLOR. 

are  costive.  The  catamenia  are  rather  less  frequent, 
and  less  in  quantity  ;  and  their  appearance  has  always 
been  irregular,  at  six  weeks,  or  at  two  months. — The 
following  is  my  patient's  own  account  6f  her  present 
fitate  of  health  : — *  At  first  I  had  almost  constantly  a 
pain  at  my  stomach,  and  sometimes  in  my  head  ;  my 
hands  and  feet  were  generally  cold ;  1  had  often  a 
fluttering  at  my  heart,  and  a  pain  in  my  side,  some- 
times in  the  right,  and  sometimes  in  the  left ;  1  had 
also  very  frequently  a  pain  in  each  side  of  my  back, 
a  little  below  the  shoulder  |  my  appetite  was  bad,  and 
1  was  altogether  exceedingly  weak  and  feeble.  My 
health  is  now  much  better  ;  I  very  seldom  feel  any  of 
the  complaints  which  I  have  mentioned,  except  the 
pain  in  my  head  ;  what  I  suffer  most  from  now,  is  the 
Gravel  October  SSnd,  1818.'-— February  ^Sth,  1819. 
^  In  reply  to  your  questions  I  beg  to  state  that  I  have 
passed  blood  five  times ;  the  first  time  was  in  the 
month  of  January,  1818 ;  the  second  in  March,  the 
third  in  December,  the  fourth  in  January  1819.  and 
the  last  on  the  25th  and  6th  of  this  month.  Previ- 
ously to  passing  the  blood,  I  have  always  a  pain  on 
the  left  side  of  my  bowels,'  (the  seat  of  the  sigmoid 
flexure  of  the  colon,)  '  but  not  at  any  other  time,  ex- 
cept on  coughing.  With  respect  to  the  gravel  I  think 
that  I  brought  you  the  first  specimen  last  October,  and 
the  last  in  the  beginning  of  this  month.' 

2-l<7.  Case  LVIIL    Before  I  proceed  to  the  exem- 
plitcation  of  the  other  forms  of  the  Mimorls  Decolor, 


DESCRIPTION,  WITH  CASES.  135 

X  wish  to  insert  the  following  interesting  case,  whicU 
appears  to  unite  in  some  degree,  the  character  of  thes 
more  continued  form  of  Mimosis  Acuta  with  that  of 
Mimosis  Decolor.  Mi^^s  J  aged  18.  October  the 
29th,  1818.  The  breath  has  been  tainted  and  the 
mouth  has  been  foul  and  disagreeable,  for  many  years* 
She  first  began  to  complain  a  good  deal  three  or  four 
years  ago.  During  this  interval  there  has  been  some- 
times pain  of  the  head  with  vertigo  and  intolerance  of 
noise  ;  sometimes  pain  of  one,  and  generally  but  not 
always  of  the  left,  side,  striking  to  the  back ;  some- 
times fluttering  at  the  pit  of  the  stomach,  especially 
on  lying  down  ;  sometimes  faintness  ;  often  distressing 
fulness  from  wind  at  the  stomach  ;  and  frequently  se- 
vere hiccough  ;  sometimes  much  gaping  ;  aching,  hea- 
viness, and  sense  of  numbness  of  the  arms.  The. 
nights  are  restless  at  first;  and  she  is  heavy  for  sleep 
in  the  morning.  She  is  nervous,  easily  fluttered  and 
startled  by  a  sudden  noise  or  other  occurrence.  The 
pulse  is  generally  about  96,  and  often  irregular.  The 
bowels  become  tumid  in  the  evening ;  they  are  habit- 
ually costive. — The  face  is  puflPed  and  bloated  in  gen- 
eral, and  sometimes  to  a  much  greater  degree  than  at 
present ;  the  complexion  is  sallow,  with  a  dark  yel- 
lo  vness  of  the  eye-lids  and  about  the  mouth  ;  just  now 
there  is  a  deepish  diffused  flu«h  of  the  cheeks,  but  this 
is  rare.  The  tongue  is  very  white,  loaded,  and  clam- 
my, with  enlargement  of  the  papillse  ;  the  gums  ex- 
ceedingly swollen ;  the  mouth  in  general,  very  dis^ 
agreeable,  and  the  breath  extremely  tainted.     The 


13fl  THE  MIM05IS  DECOLOR. 

ton«*ue  occasionally  becomes  rather  dry.  The  hands 
are  puffed  in  a  remarkable  degree ;  the  fingers  and 
nails  of  a  light^  delicate  blue  5  the  tips  of  the  nails 
white  and  opaque.  The  appetite  is  impaired.  The 
bowels  constipated  and  the  operation  of  medicines 
scanty.  The  catamenia  have  been  irregular  until  the 
three  last  periods,  which  have  been  regular  ;  their  ap- 
pearance is  natural  in  quantity  and  colour. 

218.  The  following  case  exemplifies    the  form  of 
Mimosis  Decolor  as  it  results  from  haimorrhagy  :— 

249.  CaseLIX.  S.  B.  aged  27.  Dec.  3,  1818. 
She  has  been  employed  in  '  mending/  13  years.  Her 
health  suffered  about  six  years  ago,  and  she  became 
affected  with  headach,  and  vertigo,  the  bowels  be- 
came constipated,  and  the  flow  of  the  catamenia  was 
attended  with  much  pain.  Three  years  ago  she 
ceased  to  have  the  catamenia  regularly,  and  some- 
times they  were  absent  three  months.  About  a  year 
and  a  half  ago  she  became  pregnant,  and  subject  to 
leucarrhcea.  She  lost  much  blood  during  labour,  has 
suckled  her  infant,  but  has  very  little  milk.  At  pre- 
sent the  countenance,  prolabia,  and  tongue,  are  ex- 
tremely pale  and  exauguious, — with  a  slight  tinge  of 
yellow,  and  a  degree  of  darkness  round  the  eyes.  The 
tongue  is  pale,  of  a  peculiar  pale,  transparent,  lilac 
hue,  clean,  but  marked  by  the  teeth  at  the  edges. 
The  feet  are  slightly  cedematous  towards  evening. 
The  skin  is  generally   dry,  but   the  hands  become 


DESCRIPTION,  WITH  CASES.  137 

moist  when  she  is  fluttered.  She  has  still  heatlach 
and  vertigo ;  and  a  fluttering  about  the  proccordia 
on  the  slightest  hurry ;  and  some  dry  cough.  Slie 
has  also  suffered  from  hiccough,  and  eructation. 
Her  appetite  is  tolerable  but  she  experiences  a  load 
after  eating.  The  bowels  still  costive, — often  two 
or  three  days  without  a  stool.  No  catamenia  since 
the  birth  of  her  infiint.  She  still  continues  her  se- 
dentary work, 

550.  The  following  cases  are  examples  of  the  In- 
veterate Stage  of  the  Mimosis  Decolor  : — 

551.  Case  LX.  Miss  M.  F,  aged  19,  sister 
to  the  patient  wliose  case  is  given  §  ^39.  Her  com- 
plaints began  in  1815,  three  years  ago,  and  have 
during  this  interval  been  so  various,  multiform,  and 
numerous  as  almost  to  preclude  description  or  even  a 
full  enumeration.  The  case  affords,  however,  such  a 
remarkable  illustration  of  the  inveterate  stage  of  the 
Mimosis  Decolor,  described  §  SS3,  as  to  render  it 
highly  desirable  that  it  should  be  recorded. — Even 
before  the  date  of  the  commencement  of  this  affection, 
given  above,  the  general  appearance  of  health  and 
spirits  in  Miss  F.  was  observed  to  have  declined.  She 
gradually  lost  her  Colour  and  some  flesh,  became  ner- 
vous, listless,  dispirited,  and  fainty.  Since  1815,  she 
has  been  continually  an  invalid  ;  she  has  kept  her 
room  for  many  months,  and  her  bed,  for  many  weeks 
together.      The    countenance,    prolabia,   guiiis,  and 


138  THE  MIMOSIS  DECOLOR. 

tongue,  the  hands,  fingers,  and  general  surface,  have 
become  exanguious  ;  the  face  is  rather  tumid ;  the 
skin  opaque  and  puffy;  the  legs  and  ankles  very 
(fidematous.  There  has  been  a  very  slow  but  gradual 
loss  of  flesh.  The  pulse  is  frequent,  often  about  100, 
but  easily  accelerated  to  much  greater  frequency. 
The  appetite  is  various,  and  when  any  thing  is  taken, 
it  is  generally  something  of  an  indigestible  nature  : — 
once  she  took  great  quantities  of  pickles  ; — at  other 
times  toasted  cheese,  or  frizzled  meat,  is  the  only 
thing  she  can  eat.  The  bowels  have  always  been  tor- 
pid. The  catamenia  have  been  suppressed  for  a  con- 
siderable time. — This  patient  was  confined  to  her 
Louse  and  to  her  room  for  several  years.  She  has 
recovered,  however,  at  length.  Her  sufferings  have 
sometimes  appeared  to  be  partly  corporal  and  partly 
mental.  They  were  always  aggravated  by  surprise^ 
agitation f  or  noise  ;  they  recurred  much  in  the  even- 
ing, and  in  various  succession.  They  were,  as  well 
as  the  REMEDIES  employed,  various,  and  multiform 
in  the  greatest  degree.  The  detail  will  be  given  un- 
der the  head  of  the  Mimosis  Urgens. 

252.  Case  LXI.  presents  the  inveterate  stage 
of  the  Mimosis  Decolor,  under  a  different  aspect. — 
E.  B.  aged  46,  servant.  April  10th,  1817.  Her  com- 
plaints have  come  on  very  gradually,  beginning  ten 
years  ago.  She  had,  at  first,  dull  pain  of  the  head, 
*  pain  of  the  left  side,  nausea,  and  sickness  ;  the  bowels 
were  constipated  5  and  there  was  a  difficulty  in  void- 


DESCRIPTION,  WITH  CASES.  139 

iiig  urine. — At  present  she  has  lost  all  of  a  good  com- 
plexion ;  the  countenance  is  affected  with  a  variable 
sallowness   and  yellowness,  but  the  conjunctivaj  are 
untinged ;    both  eyelids    are    affected   with  a  puffy 
swelling,  and  with  a  yellow-black  hue.     The  lips  and 
gums  are  pale  ;  the  mouth  clammy  ;  the  tongue  is  load- 
ed at  the  back  but  less  so  at  the  fore  part,  indented  at 
its  sides,  and  sometimes  affected  with  swelling.    The 
skin  is  always  free  from  perspiration,   and   morbidly 
dry  ;  on  the  hands  it  is  yellowish,  opaque,  and  some- 
times puffy  ;  the  nails  have  become  brittle  and  break 
on  the  slightest  occasion.     The  ankles   swell  in  the 
evening.     I? he  is  liable  to  headach.     She  is  easily 
hurried  and  fluttered.     She  has  sometimes  fits  of  vio- 
lent coughing,  which  continue  for  half  an  hour,  some- 
times with  retching,  but  without  expectoration.    There 
is  no  dyspnoea.     There  is  sometimes  palpitation  of  the 
heart.     The  pulse  is  generally  96.     The  catamcnia 
are  regular  in  their  periods,  but  Avithout  colour,  and 
scanty;  at  each  period  the  colour  and  quantity  dimin- 
ish, and  the  flow  is   attended  with  greater  nervous- 
ness.    Tiiere  is  no  dysury  now,  but  the  urine  is  scanty. 
The  appetite  is  various ;  she  is  fond  of  chewing  tea- 
leaves.     The  bowels   are  costive.      Purgatives  with 
calomel,   rhubarb,  and   aloes,  were  prescribed. — On 
May  l6th  the  following  report  was  made  : — The  com- 
plexion  is  greatly  restored;  the  hands  are  become 
moist.     She  has  gained  flesh  ;  and  all  her  complaints 
are   relieved.     The  medicines  were  continued. — On 
August  the  30th  the  following  statement  was  made  : — 


-t 


140  THE  MIMOSlS  DECOLOR. 

This  patient's  complaints  have  varied,  being  better 
and  worse,  since  the  last  report ;  but  on  the  whole 
they  are  aggravated,  and  especially  lately.  The  pale- 
ness of  the  countenance  is  augmented,  with  less  yel- 
lowness;  there  is  much  oedema  or  rather  anasarca, 
passing  up  the  thighs  even ;  the  pulse  is  more  fre- 
quent,— about  108  ;  the  tongue  is  pale,  white,  swol- 
len and  indented ;  the  bowels  are  kept  open  ;  the 
catamenia  appear  regularly  but  are  colourless  :  the 
urine  is  clear  ;  the  apetite  moderate. — After  this  date 
the  anasarca  gradually  disappeared.  But  the  patient 
remains  still  much  as  she  was  in  May  1817- 

253.  The  ensuing  cases  present  the  symptoms  and 
appearances  of  the  chronic  form  of  the  Mimosis  De- 
color : — 

S54.  Cask  LXIL  R.  B.  aged  33.  April  7ib, 
1817-  She  has  been  engaged  in  the  sedentary  occu- 
pation of  chevening  during  fifteen  years.  She  had 
formerly  a  good  colour,  which  began  to  fade  about 
three  years  ago.  The  bowels  have  generally  been 
constipated.  Her  complaints  have  augmented  consid- 
erably during  the  last  year. — At  present  the  counte- 
nance in  general  is  pale  and  sallow,  and  the  prolabia 
and  gums  are  exanguious.  The  hands  are  also  pale  ; 
the  skin  dry  and  often  opaque ;  the  general  surface  is 
deprived  of  its  wonted  perspiration.  There  has  been 
some  loss  of  flesh.  There  is  some  oedema  of  the  ankles 
towards  evening.     The  tongue,  formerly  loaded  with 


DESCRIPTION,  WITH  CASES.  141 

a  disagreeable  state  of  the  mouth  and  tainted  breath, 
is  now  moist  and  clean.  Hhe  suffers  from  variable 
pain  of  the  head,  which  is  sometimes  severe,  some- 
times absent,  sometimes  gradual,  and  sometimes  sud- 
den in  its  attacks.  Hhe  is  nervous.  She  experiences 
violent  palpitation  of  the  heart  at  times.  No  cough. 
Recurrent  pain  of  each  hypochondre,  and  of  the  back. 
The  bowels  are  now  regular  ;  they  were  formerly  con- 
stipated, but  never  affected  with  diarrhoea.  Ihe  ca- 
tamenia  are  less  in  quantity,  light  coloured,  and  at- 
tended with  much  pain.  The  urine  deposits  a  red 
sediment. — ^^On  April  the  lOth,  the  complaints  remain- 
ed nearly  as  before,  with  the  exception  of  diminished 
pain  of  the  head. — On  May  the  13th,  all  the  com- 
plaints are  diminished ;  the  complexion  is  much  im- 
proved ;  but  the  skin  remains  dry ;  the  headach  and 
nervous  symptoms  have  disappeared  ;  but  she  suffers 
from  pain  of  the  back  ;  she  walks  with  far  less  fatigue. 
— The  amendment  in  this  patient  was  long  progres- 
sive ;  but  she  gradually  relaxed  in  taking  her  gentle 
purgative  medicines  and  daily  exercise,  and  as  she 
resumed  fully  her  sedentary  occupation  she  became 
again  more  or  less  liable  to  the  symptoms  and  affec- 
tions of  the  chronic  form  of  the  Mimosis  Decolor. 

255,  Case  LXIII.  C.  R.  aged  S8,  housemaid. 
The  following  complaints  began  six  or  seven  years 
ago,  and  made  a  slow  and  varied  progress  until  about 
a  year  ago,  since  which  time  they  have  been  nearly  as 
about  to  be  described.      At  first  there  was  a  loss  of 


143  THE  MIMOSIS  DECOLOR. 

complexion  and  a  sensible  loss  of  flesh  ;  attacks  of  pain 
of  the  head  and  of  the  right  hypochondre  ;  vertigo  ; 
fluttering,  and  palpitation  of  the  heart ;  fits  of  violent 
dry  cough,  with  retching ;  alternate  constipation  and 
diarrhoea ;  the  catamenia  attended  with  great  pain  of 
the  back  and  lower  part  of  the  abdomen,  and  an  ap- 
pearance of  paleness  and  coldness  in  the  countenance, 
with  bhieness  of  the  lips  ;  the  flow,  too,  would  begin 
in  the  morning,  cease,  and  recur  when  she  went  to 
bed,  the  colour  and  quantity  being  nearly  natural. — 
At  present  the  countenance  is  yellowish  and  icterodc, 
with  a  little  redness  of  the  cheeks,  but  a  general  ap- 
pearance of  paleness.  This  colour  varies  exceedingly, 
and  there  are  alternations  of  paleness,  and  yellowness, 
w  ith  darkness  of  the  eye-lids,  at  different  times.  The 
skin  is  often  rather  hot.  The  nails  are  split,  sunk  in 
the  middle,  and  easily  broken.  The  tongue  is  clean, 
moist,  and  almost  natural.  She  su-ffers  from  attacks 
of  pain  occupying  the  crown  of  the  head,  and  occur- 
ring particularly  when  she  is  employed  near  the  fire, 
or  more  than  usual.  She  experiences  vertigo  on  stoop- 
ing. The  pain  of  the  right  hypochondre  often  occurs 
during  the  morning,  without  obvious  cause,  and  is  of 
an  achins:  kind.  There  are  sometimes  fits  of  difficul- 
ty  of  breathing,  which  are  compared  to  that  of  a  per- 
son out  of  breath  from  active  exertion.  The  fluttering 
and  palpitation  are  induced,  like  the  pain  of  the  head, 
by  working  too  near  the  fire.  The  pulse  is  nearly  nat- 
ural. There  has  been  no  loss  of  flesh  daring  the  last 
year,  except  perhaps  a  little  in  the  face.     There  was 


^^. 


PP:SCRIPTION,  WITH  CASES.  14i3 

formerly  a  little  oedema^  but  not  lately.  She  is  affect- 
ed with  leacorrhoea. — These  complaints  are  already 
mitigated,  and  the  complexion  improved  by  adopting 
a  course  of  purgative  medicine.  The  leucorrhoca  is 
quite  removed  by  a  lotion  with  sulphat  of  zinc,  insert- 
ed, by  means  of  a  scroll  of  linen,  into  the  vagina. — 
A  still  further  amendment  takes  place  in  this  patient : 
— the  complexion  improves,  the  mammae  from  being 
flaccid  are  now  tumid  and  much  enlarged ;  she  has 
during  the  last  three  weeks  gained  2lb.  of  flesh  ;  the 
strength,  capability  of  exertion,  and  the  general  health 
are  equally  much  improved. — It  is  now  fourteen 
months  since  she  applied  to  me,  and  she  continues  well^ 
being  fresh  coloured,  jolly,  and  free  from  her  many 
painful  complaints.  The  nails  have  much  recovered, 
and  the  leucorrhcea  is  removed. 

Sj6.  The  following  cases  exemplify  the  appear- 
ance of  the  Mimosis  Decolor  in  married  females,  and 
illustrate  the  paragraph,  §  236  ; — 

257.  Case  LXIV.  Mrs.  C.  aged  32,  and  mother 
of  seven  children.  April,  1816.  This  patient  refers 
her  complaints  to  mental  distress  :  they  took  place  in- 
sidiously, about  five  years  ago,  and  three  years  and  a 
half  ago  she  was  induced  to  apply  to  medicine.  At 
first,  Mrs.  C.  was  affected  with  recurrent  pain  of  the 
head,  under  the  sternum,  of  the  right  side,  and  of  the 
bowels.  She  was  alternately  constipated  and  affected 
with  diarrhoea,  but  habitually  of  a  costive  habit.— At 


144?  THE  MIMOSIS  DECOLOK. 

present  there  is  a  pale  yellowness  of  the  complexion  J 
the  upper  and  under  eye-lids  are  pulffy  and  dark  co- 
loured 5  the  Conjunctiva  is  white ;  the  face  is  apt  to 
be  somewhat  swollen  in  the  morning.  The  lips,  guras^ 
and  tongue  are  pale  ;  the  tongue,  formerly  loaded,  is 
now  clean ;  the  breath,  formerly  tainted,  is  now  inof- 
fensive. The  hands  ^rc  very  pale,  sometimes  a  little 
puiTy.  The  ankles  are  apt  to  be  (Edematous  in  the 
evening.  The  skin  in  general  is  yellowish  and 
opaque,  and  always  dry.  There  are  great  languor, 
listlessness,  incapability  for  exei'tion  ;  and  some  loss 
of  memory  and  mental  energy.  Formerly  there  was 
acute  pain  of  the  head ;  lately  the  pain  has  been  dul- 
ler, with  vertigo,  tinnitus,  aurium,  or  a  momentary 
defect  of  sight.  There  is  some  heaviness  for  sleep. 
She  is  easily  hurried  and  fluttered.  There  is  much 
despondency.  The  appetite  is  various, — -sometimes 
fastidious,  sometimes  voracious  ;  she  is  particularly 
fond  of  chewing  grits.  The  alvine  evacuation  is  very 
offensive.  Mrs  C's  youngest  child  but  two  is  four 
years  old  ;  the  youngest  but  one  was  born  a  year  and 
a  half  ago  ;  the  youngest  nine  weeks  ago  ;  the  cata- 
meaia  had  generally  appeared  once  between  each 
pregnancy,  but  this  was  not  the  case  between  the 
last  but  one  and  the  last,  which  was  not  suspected 
until  far  advanced.  Mrs.  C.  has  scarcely  been  able 
to  suckle  her  three  last  children. — This  patient  has 
recovered  in  a  very  great  degree  from  her  complaint, 
by  a  persevering  use  of  calomel,  and  of  rhubarb  and 
aloe  tic  pills,  and  she  enjoys  at  present  a  very  good 


DESCRIPTION,  AVITH  CASES.  145 

state  of  health.  Her  complexion  is  greatly  improved  ; 
but  it  is  apt  to  be  affected  vvheuever  she  is  accidentally 
indisposed  ;  at  such  times,  too,  she  is  reminded  of  her 
former  painful  complaints. 

258,  Cases  LXV,  LXVI,  LXVII,  and  LXVIII. 

Mrs.  T,  aged  40,  mother  of  a  family,  {she  is  affected 
with  great  paleness  of  the  countenance,  an  exanguious 
state  of  the  lips,  gums,  and  tongue,  and  paleness  of  the 
hands,  fingers,  and  general  surface.  1  o  these  appear- 
ances are  superadded  the  symptoms  of  the  Mimosis 
Decolor. — This  patient  recovered  from  the  administra- 
tion of  gentle  purgatives.^ — Mrs.  C.  aged  27,  mother 
of  two  children.  This  is  the  most  marked  instance  of 
the  pale  icterode  countenance ;  there  is  considerable 
darkness  of  the  eye -lids,  loss  of  colour  in  general,  and 
an  exanguious  state  of  the  prolabia,  with  the  several 
symptoms  of  the  Mimosis  Decolor. — Gentle  purgatives 
were  prescribed,  and  the  complexion  and  general 
health  were  gradually  improved. — Mrs.  S.  aged  50, 
is  affected  with  squalid  paleness  of  the  countenance, 
and  darkness  of  the  eye-lids,  united  with  other  ap- 
pearances, and  the  usual  symptoms  of  the  Mimosis 
Decolor. — She  has  begun  the  plan  of  gentle  purga- 
tives.—Mrs.  H.  aged  60,  was  affected  with  the  state 
of  countenance,  tongue,  general  surface,  and  symp- 
toms, observed  in  the  Mimosis  Decolor,  together 
with  an  eruption  of  Urticaria  in  large  wheals,  without 
redness,  sometimes  solitary,  but  sometimes  more  uu- 
^iner(ws,  and  appearing  particularly  upon  the  legs, 

T 


146  THE  MIMOSIS  DECOLOR. 

^9.  Case  LXIX.  E.  T.  aged  35,  engaged  at 
the  sedentary  occupation  of  '  mending  ^  May  ^8j 
1816.  This  patient's  complaints  began  eight  years 
ago.  Daring  this  long  interval  she  has  suffered  from 
severe  pain  of  the  head,  of  the  left,  and  sometimes  of 
the  right,  side  ;  faintness  ;  weakness ;  nervousness, 
and  despondency.  The  bowels  have  always  been  con- 
stipated. The  catameuia  appear  regularly,  but  are 
very  scanty  and  light  coloured.  From  possessing  a 
fresh  complexion,  she  has  become  pale  and  yellow. 
The  tongue,  at  first  loaded,  is  become  clean,  and,  with 
the  lips  and  gums,  very  pale.  The  face,  hamls,  and 
ankles  are  apt  to  be  swollen ;  but  especially  the  eye- 
lids, and  particularly  in  the  morning.  The  skin  is 
very  dry.  About  two  years  ago  the  nails  became, 
from  being  strong,  very  thin,  brittle,  exfoliating  in 
layers,  and  sunk  in  the  middle. — This  patient  recov- 
ered in  great  measure  by  a  persevering  use  of  gentle 
purgative  medicines.  The  complexion,  surface,  cata- 
menia,  and  bowels,  became  more  natural  -^S lie  mar- 
ried about  a  year  and  a  half  after  she  became  my  pa- 
tient, and  is  now  the  mother  of  a  fine  boy. 

S60.  The  following  case  exemplifies  the  occurrence 
of  the  Mimosis  Decolor,  in  its  most  marked  form  in  the 
Male  Sex: — 

g61.  Case  LXX.  G.  S.  aged  37.  May  5,  1819. 
Nearly  4  years  ago  he  became  affected  with  vomiting 
and  diarrhoea.      Since  that  time  he  has  lost  his  health, 


DESCRIPTION,  WITH  CASES.  147 

add  has  been  subject  to  disorder  of  the  stomach  and 
bowels---constipation  alternating  with  looseness, — 
with  recurrent  pain  of  the  stomach  and  of  the  bowels. 
He  lost  his  colour,  flesh,  and  strength ;  but  first,  and 
principally,  his  colour.  8ix  weeks  ago  he  was  taken 
in  the  night  with  gaping  followed  by  vomiting,  by 
which  some  blood  was  raised  of  a  black  colour ;  the 
bowels  were  costive,  and  he  was  aftected  with  vertigo. 
A  month  and  a  fortnight  ago  he  again  vomited  blood, 
and  the  last  time  he  passed  blood  by  stool.  He  be- 
came extremely  pale  and  sallow,  and  very  feeble,  and 
lost  flesh.  He  complained  of  pain  dulness,  and  heav- 
iness across  the  temples,  and  vertigo  ;  and  during 
the  last  fortnight  he  has  complained  of  fluttering  and 
strong  beating  of  the  heart :  of  nervousness  ;  and 
some  pain  of  the  stomach  and  bowels.--- When  I  first 
saw  him  thje  countenance  was  extremely  pale  and 
yellow,  with  some  darkness  of  the  eye-lids  ;  the  pro- 
labia  exanguious  ;  tll6  eyes  perfectly  white.  The 
hands  fingers  and  nails  were  pale  and  exanguious. 
He  complained  as  stated,  of  the  head,  and  of  fluttering 
at  the  heart  and  stomach.  Pulse  96  and  strong. 
Tongue  pale,  white,  and  furred.  No  thirst.  Stools 
Tvith  flakes  of  mucus,  without  odour,  and  with  blood 
of  a  dark  colour.  No  disease  perceptible  in  the  abdo- 
men on  examination.  No  cough  or  dyspncEa,  A  de- 
gree of  shivering,  l)ut  no  feverishness,  or  perspiration. 
He  has  been  better  and  worse. — He  has  had  haema- 
temesis  three  times,  at  intervals  of  a  fortnight,  having 
})een    taken  with  gaping,    nausea,    and   vomiting  of 


148  THE  MIMOSIS  DECOLOR. 

blood,  mucus,  and  a  little  food.  During  one  day, 
he  voided  blood  by  stool  with  mucus  ;  and  he  has  long 
voided  stools  resembling  tar  in  appearance. — 1  his  af- 
fection began  three  or  four  years  ago, — just  at  the 
time  he  exchanged  his  point-net  frame  in  which  he 
worked  with  a  double  thread,  for  one  in  which  a 
single  thread  was  worked.  In  the  latter  there  is 
great  danger  of  the  thread  breaking,  by  which  acci- 
dent the  sacrifice  of  several  inches  of  the  work,  and 
if  several  perhaps  an  hour's  labour,  was  obliged  to 
be  made.  On  these  occasions,  as  he  states,  his  heart 
would  jump  into  his  mouth,  and  his  whole  frame 
received  a  shock  from  which  he  did  not  recover  per- 
haps for  a  considerable  time.  He  also  became  ex- 
tremely timid,  apprehensive,  and  nervous,  in  a  very 
extraordinary  degree.  This,  together  with  sendentari- 
ness,  appears  to  have  been  the  cause  of  his  complaint. 
May  15.  Purgative  medicines  have  been  continued 
regularly.  He  has  had  neither  hsematemesis  nor 
melseua.  The  stools  for  several  days  were  flakes  of 
mucus  only ;  they  have  gradually  become  more  fsecu- 
lent.  His  complexion,  the  colour  of  the  hands,  appe- 
tite, and  general  health  are  much  improved.  But 
there  is  still  much  weakness,  and  some  dizziness,  and 
after  a  stool,  a  degree  of  fatigue  with  slight  fluttering. 
He  is  far  less  nervous.  He  has  ceased  to  lose  flesh 
the  last  week.  September  14,  1819.  He  has  contin- 
ued uniformly  to  improve  in  strength,  flesh,  com- 
plexion, appetite,  and  in  every  respect,  having  better 
health  now  than  for  three  or  four  years  past.     He  has 


DESCRIPTION,  WITH  CASES.  149 

however  still  occasional  returns  of  paleness  and  sal- 
lowness,  of  dizziness^  and  of  the  feeling  of  sinking. 
The  pulse  is  76  and  natural  in  every  respect. 

262,  The  appearances  and  symptoms  of  the  Mi- 
mosis  llecolor  have  occurred  in  a  boy  of  14,  much 
confined  in  school ;  in  a  youth  of  17?  occupied  as  a 
tailor ;  and  in  a  young  man  of  20,  a  painter. 

263.  The  different  appearances  and  forms  of  the 
Mimosis  Decolor  are,  I  think,  sufficiently  illustrated 
by  the  cases  already  given  ;  I  suppress,  therefore,  ma- 
ny others  formerly  intended  for  insertion  in  this  work. 
The  accession  of  this  affection  is  slow  and  insidious  in 
the  highest  degree  ;  the  incipient  stage  sometimes  re- 
quires many  months  for  its  developement,  and  occu- 
pies a  longer  period  5  tl\e  confirmed  stage  frequently 
subsists  for  one  or  two  years  ;  and  the  inveterate  stage 
for  an  indefinite  period, — being  long  stationary,  lead- 
ing to  the  more  chronic  form,  to  the  slow  formation  of 
dropsies,  or  organic  disease^  or  of  a  viscous  affection, 
to  a  slowly  progressive  loss  of  flesh  and  of  the  powers 
of  life. 

264.  The  course  of  this  affection  is  irregular. 
Sometimes  purgatives  medicines  induce  immediate  re- 
lief ;  but  this  does  not  continue  ;  a  more  slow,  regular, 
and  progressive  amendment  is  usually  more  permanent. 
There  are  attacks  of  the  urgent  symptoms,  and  the 


i50  THE  MIMOSIS  DECOLOR, 

patienl;  is  better  and  worse,  even  during  the  general 
amendment. 

265.  The  more  acute  form  admits  more  readily  of 
remedies  than  the  more  chronic,  except  in  the  invete- 
rate stage.  But  all  our  efforts  are  apt  to  be  thwarted 
by  want  of  perseverance  on  the  part  of  the  patient,  by 
a  return  to  a  sedentary  occupation  or  mode  of  life,  and 
by  a  relaxation  in  taking  the  gentle,  tonic  purgatives 
to  be  recommended  hereafter. 

266.  June  13,  1819.  I  have  this  day  had  the  op- 
portunity of  ascertaining  by  a  caneful  dissection,  that 
in  a  case  of  Mimosi&  Decolor,  long  considered  a  case 
of  '  Liver  Complaint,'  there  was  no  perceptible  dis- 
ease of  that  or  any  other  viscus. 


THE  DIAGNOSIS.  151 


SECTION  II.    THE  DIAGNOSIS^ 


I.  THE  DIAGNOSIS  OF  THE  GENERAL 
AFFECTION. 


567.  The  Mimosis  Decolor  in  general,  requires  to 
be  particularly  distinguished  from  the  most  Insidi- 
ous forms  of  Organic  Disease.  Its  complications 
require,  as  I  have  stated  §  227 ^  to  be  discriminated 
both  from  SuddFiN,  and  the  Insidious,  Local  Af- 
fections. 

568.  From  Insidious  Organic  Disease,  the  Mirao* 
sis  Decolor  is  distinguished  by  the  state  of  the  com- 
plexion, of  the  general  surface,  and  of  the  tongue ;  by 
the  variety  and  multiplicity  of  its  symptoms,  and  of 
the  organs  or  functions  affected  ;  and  by  its  irregular, 
varied,  and  protracted  course.  In  Organic  Disease 
the  countenance  is  pale,  perhaps  partially  flushed,  or 
affected  as  described  §  7%  or  ^  101,  and  there  is  an 
expression  of  pain,  uneasiness,  or  disease,  with  an  ear- 
ly and  progressive  emaciation  ;  whilst  there  is  an  ab- 
sence of  the  peculiarity  of  countenance  observed  in 
the  Mimosis  Decolor,  §§  208,  215,  225,  229,  236, 
The  surface  in  organic  affection  is  equally  destitute  of 
the  charatters  given  §^  209,  216,  230,  but,  on  the  con- 
trary, often  remains  nearly  natural,  but  is  apt  to 
be  affect'cd  by  Hie  different  states   of  symptomatic  fSr 


152  THE  MIMOSIS  DECOLOR. 

brile  affection.  The  tongue  is  free  fmra  tlie  appear- 
ances described  §§  210,  2i7,  S31,  except  when  tlierc 
is  disorder  of  the  stomach  superadded  to  the  organic 
disease.  There  is  an  absence  of  the  characters  of  Mi- 
mosis  and  of  the  Mimosis  Decolor,  §§  1,  2,  207^  235  ; 
Contrast  further  the  description  given  of  Insidious 
Organic  Disease,  §§  71^  197- 

269.  The  state  of  the  complexion,  the  tinge  oF 
surface,  and  the  seat  of  pain,  in  the  Mimosis  Decolor, 
lias  very  frequently  led  to  the  suspicion  of  Chronic 
DisKASE  OF  THE  LiVER.  The  Diagnosis  is  made 
by  an  attention  to  the  contrast  of  symptoms  drawn  in 
the  last  paragraph,  by  observing  the  state  of  the  pro- 
labia,  conjunctiva,  urine,  and  fences,  by  ascertaining 
the  recurrent  nature  of  the  pain  of  the  side,  and  by  a 
careful  examination  of  the  region  of  the  Liver. — By 
these  means  the  list  of  Chronic  Diseases  of  tlie  Liver 
would  be  considerably  curtailed,  for  I  can  recall,  at 
ibis  moment,  numerous  instances  of  this  error  in  Di- 
agnosis.    This  subject  will  be  resumed  shortly. 


THE  DIAGNOSIS.  453 


HE  DIAGNOSIS  OF  THE  COMPLICATIONS. 


S70  The  patient  affected  with  the  Mimosis  Deco- 
lor is  liablfc  to  sudden  attacks  of  the  affections  enu- 
merated §  22Q ;  •and  h*  is  liable  to  these  affections  in 
a  recurrent  or  in  a  more  or  less  continued  form.  This 
circumstance  renders  it  necessary  to  distinguish  the 
complications  of  this  affection  from  the  Sudden  and 
the  Chronic^  Local  Diseases. 

S71.  The  Mimosis  Decolor  with  Affection  of  the 
Head,  is^  in  various  instances,  mistaken  for  Sudden 
Tendencies  or  Congestions  of  Blo6d  with  regard  to 
the  Brain,  and  for  Insidious  or  Chronic  Inflammation 
of  this  organ. 

gya.  Case  LXXT.  Mrs.  C.  of  B.  aged  15.  She 
is  affected  with  the  Mimosis  Decolor,  characterized  by 
a  ring  of  deep  darkness  round  the  eye-lids,  and  a  lit- 
tle cast  of  yellow  tinge,  but  united  with  a  full  colour 
of  the  face  and  prolabia.  The  tongue  is  affected  ;  and 
there  are  the  variety  of  symptoms  denoting  the  Mimo- 
sis Decolor.  This  lady  has  fpr  many  years  been  sub- 
ject to  attacks  of  violent  pain  of  the  head,  ac- 
companied with  a  sense  of  constriction  about  the  neck, 
for  which  bleeding,  blisters  and  a  seton,  have  been  va- 
riously recommended  by  various  practitioners.  Thor 
affection  continued  to  recur  notwithstanding,  for  very 
many  years,  always  inducing  the  fear  of  some  attack 
u 


154  THE  jNIIMOSIS  DECOLOR. 

of  an  apoplectic  nature.  It  has  yielded,  however,  to 
a  persevering  use  of  efficient  purgative  medicines.  It 
has  recurred  from  mental  anxiety  and  the  fatigue  of 
company ;  and  there  are  shedding  of  tears,  pain  at 
the  stomach,  headach,  &c,  the  complexion  being 
aftectcd  more  on  each  attack.  It  has  also  more  lately 
changed  its  form  and  induced  attacks  of  pain  at  the 
stomach. 

S73.  Case  LXXIT.  The  first  case  in  which  I  saw 
the  importance  of  these  distinctions,  had  been  succes- 
sively treated  as  Inilammation  of  the  lirain,  and  as 
lijlhimmatiou  of  tlie  Liver, — by  bleeding,  leeches,  and 
blisters  to  an  almost  incredible  extent  I  'Ihe  patient 
was  first  long  subject  to  severe  pain  of  the  head, 
and  afterwards  to  pain  of  the  right  side.  There 
were  superadded  the  appearances  and  symptoms  of  the 
Mimosis  Decolor.  The  patient  perfectly  and  even 
promptly  recovered,  by  pursuing  an  efficient  course  of 
purgative  medicines. 

274.  If,  in  the  sudden  cases,  the  countenance, 
tongue,  surface,  and  functions  be  distinctly  afl^ected  as 
in  the  Mimosis  Decolor,  there  is  a  great  jjresumpilon 
that  there  are  only  symptomatic  pain  and  affection  of 
the  head. — The  history  of  the  case,  and  of  the  attack, 
will  also  assist  the  Diagnosis ; — the  patient  has  been 
repeatedly  liable  to  a  similar  affection,  and  the  attack 
has  probably  been  preceded  or  attended  by  unequivo- 
cal symptoms  of  the  Mimosis  Decolor* — The  effects  of 


THE  DIAGNOSIS.       ,  too 

remedies  may  also  suggest  the  Diagnosis  ;  on  this 
point  some  ohservations  will  be  made  in  considering 
the  treatment  of  the  complications  of  the  Miniosis 
Decolor. 

275,  With  these  remarks  the  reader  may  compare 
and  contrast  tlie  following  character  of  the  Threaten- 
ing of  Apoplexy. — '  An  attack  of  apoplexy,  or  of 
paralysis,  may  be  apprehended  on  the  occurrence  of 
any  of  the  following  symptoms  ;  especially  if  the  per- 
son, by  hereditary  disposition,  constitution,  form  of 
boily,  age,  or  habits,  be  predisposed  to  these  aiFections: 
— A  sense  of  flushing  and  of  fulness  about  the  head, 
or  epistaxis  5  heaviness,  dull  headach,  vertigo ;  un- 
usual drowsiness,  or  stupor,  disturbed  sleep,  incubus, 
stertor ;  forgetfulness,  timidity,  confusion  of  mind  ; 
change  of  affections,  and  tendency  to  laughter  or  tears 
from  apparent  iuibecility  ;  affection  of  the  senses,  as 
temporary  loss  of  sight,  flashes  of  light,  double  vision? 
singing,  or  loud  noises  in  the  ears  :  acute  pain  or  ten- 
derness of  the  scalp.  But  no  symptoms  are  so  mueh 
to  be  dreaded,  as  temporary  numbness  or  torpor  of  any 
of  the  iimbs,  or  transient  and  partial  weakness;  a  (le> 
feet  or  loss  of  voice  ;  a  distortion  and  an  unusual  and 
unmeaning  expression  of  the'coantenance.^ — There  are 
vsomctimes  sickness,  and  faintishness,  and  generally 
constipation  of  the  bowels.'* 

S76.  From  Insidious  or  Chronic  Inflammation  or 

*  Sec  the  trealise  on  Dii.a>-osis,  Tart  II,  §  112. 


•* 


S 


156  THE  MIMOSIS  DECOLOR. 

Disease  of  the  Brain^  the  complication  of  the  Mimosis 
Decolor  with  Affection  of  the  Head  is  also  to  be  dis- 
tin2;uished  by  the  state  of  the  complexion,  tongue^ 
and  surface ;  by  the  complexity  and  variety  of  its 
symptoms  ;  by  the  History  of  its  course  ;  and  by  the 
recurrent  nature,  or  varying  degree,  of  the  pain,  per- 
haps with  long  intervals  of  ease. 

277.  The  former  affection  is,  on  the  contrary,  de- 
noted and  distinguished  from  this  and  from  some  other 
cases  of  complication,  by  a  nearly  natural  state  of  the 
skin  over  the  countenance  and  general  surface,  and  of 
the  tongue,  and  by  definitiveness  in  the  History  and 
jjymptonis  of  the  affection.  Insidious  disease  of  the 
Brain  comes  on  with  pain,  variable  perhaps  in  degree, 
sometimes  of  a  dull  and  heavv,  sometimes  of  an  ex- 
crnciating  kind,  attended  or  succeeded  by  delirium, 
but  generally  soon  leading  to  stupor ;  the  senses  and 
muscular  system  are  variously  affected  ;  tlie  muscular 
st^^ength,  however,  is  often  little  impaired  :  the  patient 
frecjuently  takes  food  throughout  the  affection  ;  and 
there  are  often  distention  of  the  bladder  or  involun- 
tary discharges  of  uVine  and  faeces,  even  early  in  the 
disease. 

S78.  The  complication  of  Affection  of  the  Head 
with  the  Mimosis  Decolor,  has,  like  the  similar  com- 
plication with  the  Mimosis  Acuta,  assumed  the  char- 
acter of  Organic  Disease;  but  this  transition  is  less 
observed  in  the  former  case  than  in  the  latter. 


THE  DIAGNOSIS.  137 

579.  The  Cough  and  Dyspnoea  in  the  Mimosis 
Decolor,  §  22Q,  are  sometimes  rather  sudden,  and 
sometimes  more  continued,  affections.  The  former 
case  occurs  most  frequently  in  the  incipient,  the  latter 
in  the  Later  stages  of  the  Mimosis  Decolor. 

580.  In  the  more  sudden  attack  of  Cough  and 
Dyspnoea,  the  respiration  is  hurried  and  the  nostrils 
are  moved,  and  the  cough  is  very  distressing.  This 
case  is  distinguished  hy  the  character  of  the  Mimosis 
Decolor,  and  by  yielding  to  the  exhibition  of  calomel 
purgatives. — The  more  continued  case  of  Dyspnoea 
and  Cough  is  far  more  alarming,  and  is  often  attended 
by  organic  affection  within  the  chest.  It  is  distin- 
guished from  Phthisis  Pulmonalis  by  contrasting  the 
appearances  of  the  Mimosis  IJecolor  with  those  des- 
cribed §§  100,  101,  as  characteristic  of  the  former  dis- 
ease.— The  Mimosis  Decolor  may,  however,  be  com- 
bined or  followed  by  Phthisis  Pulmonalis  ;  the  prog- 
nosis should  therefore  be  very  guarded. 

S81.  The  Palpitation  of  the  Heart,  symptomatic 
in  the  Mimosis  Decolor,  ^  S26,  must  be  discriminated 
from  Organic  Disease  of  this  Organ,  by  contrasting 
the  symptoms  of  the  Mimosis  Decolor  with  tliose  de- 
tailed §  107,  as  denoting  the  latter  affection.*  This 
complication  is  most  frequent.  It  occurs  in  paroxyms, 
and  often  from  mental  causes. 

*  See  fiJrther  the  treatise  on  Diagxo«is,  pp.  213—223, 


138  THE  MIMOSIS  DECOLOR. 

ass.  Pain  and  tenderness  of  the  Side  in  the  Mi- 
mesis Decolor,  ^  3S6,  may  also  be  sudden,  or  more 
or  less  continued.  In  the  former  instance  it  may  be 
deemed  Acute,  in  the  latter.  Chronic  Inflammation  of 
the  Pleura,  or  of  the  Liver  ;  and  under  this  impression, 
bleeding  and  blisters  are  too  frequently  the  remedies 
employed,  and  the  course  of  gentle  purgatives  is  too 
much  neglected.  This  pain  is  so  common  as  to  occur 
in  most  cases  of  the  Mimosis  Decolor.  It  is,  therefore, 
doubly  important  to  establish  the  Diagnosis. 

283.  The  character,  the  symptoms,  the  multipli- 
city of  concomitant  complaints,  and  the  History,  suf- 
ficiently identify  the  state  of  Mimosis  Decolor.  But 
the  questions  remain, — is  this  affection  combined  with 
Inflammation,  or  is  there  only  an  aggravation  of  the 
Pain  of  the  Side,  so  usual  in  it  ?  The  presumption, 
a  priori,  is  that  the  pain  is  not  inflammatory.  The 
Diagnosis  may  be  further  assisted  by  observing  that 
the  pain  of  Inflammation  is  generally  regularly  pro- 
gressive in  its . formation  and  increase;  stationary  in 
its  situation,  and  incessant  in  its  duration  :  it  induces 
a  constant  expression  of  pain  in  the  countenance  ;  it 
is  often  aggravated  by  change  of  position  ;  and  it  oc- 
casions a  cautious  and  modified  state  of  respiration, 
arresting  the  movements  of  the  chest,  of  the  diaphragm, 
or  of  the  part  affected,  and  checking  a  full  inspiration, 
cough,  or  loud  expression  of  pain.  The  Pain  of  Side, 
so  usual  in  the  Mimosis  Decolor,  when  it  exists  in  an 
aggravated  form,  will  be  found,  on  a  cautious  and  vig- 


THE  DIAGNOSIS.  15^ 

ilant  observation,  to  be  various  and  irregular  in  its 
formation,  site,  degree,  duration,  and  course : — its 
accession  is  either  sudden  or  it  follows  the  more  com- 
mon state  of  Pain  of  the  Side  in  the  Mimosis  Decolor  ; 
its  situation  is  varied,  the  side  affected  is  sometimes 
changed,  or  it  appears  to  move  to  some  other  part  of 
the  course  of  the  colon,  up  the  chest,  or  towards  the 
back ;  it  varies  in  degree,  being  sometimes  less  severe, 
and  sometimes  excruciating  ;  its  duration  is  uncertain, 
and  it  frequently  ceases  suddenly,  perhaps  to  recur  ; 
a  full  inspiration  sometimes,  although  by  no  means 
tuiiformly,  increases  the  pain,  but  a  second  inspiration 
usually  induces  less  aggravation  of  the  pain  than  the 
first ;  there  is  also  more  urgent  complaint,  and  more 
expression  of  suffering  in  the  manner  of  the  patient, 
than  in  Inflammation,  which  represses  the  movements 
of  the  body,  respiration,  and  voice,  implied  in  the  out- 
ward expression  of  pain.  In  Inflammation  the  pulse 
is  also  accelerated,  and  affected  in  a  degree  not  ob- 
served in  the  complicatioi^f  the  Mimosis  Acuta  with 
Pain  of  the  Side.* 

284.  The  diagnosis  of  the  complication  of  the 
more  Protracted  Pain  of  the  Side  in  the  Mimosis  De- 
color, from  Insidious  Inflammation  of  the  Pleura,  is, 
if  possible,  still  more  important.  The  character  of 
the  case  of  complication  will  be  readily  understood 
from  the  preceding  observations.  That  of  the  latter 
ease  shall  now  be  attempted  : — 

*  See  further  the  treatise  on  Diaojtosis,  Part  U,  pp.  172, 179,  181. 


160  THE  MIMOSIS  DECOLOR. 

2B5,  111  Insidious  or  Protracted  Inflammation  "of 
the  Pleura,  there  is  an  absence  of  the  features  of  the 
Mimosis  Decolor  so  often  alluded  to.  The  nostrils 
are  rendered  acute,  and  the  alse  nasi  are  raised  by  the 
influence  of  continued  pain,  and  sometimes  moved 
by  the  respiration.  In  protracted  cases  there  are  thin- 
ness of  the  face,  and  partial  flushing  on  the  cheeks. 
The  general  surface  remains  long  natural,  but  if  the 
afPection  continues  or  advances,  there  are  emaciation, 
and  tendency  to  hectic  heat  of  the  hands,  and  perspi- 
ration more  generally.  The  pain  is  constant,  or  con- 
stantly induced  by  a  full  inspiration.  There  is  often 
a  dry  painful  cough,  suppressed  by  the  patient.  The 
pulse  is  frequent. — This  affection  sometimes  remains 
stationary  for  a  long  period ;  in  other  cases  there  is  a 
progressive  loss  of  flesh  and  strength,  with  chronic 
symptomatic  fever ;  and  in  a  third  case  there  is  the 
gradual  formation  of  Hydrothorax.* 


S86.  Pain  and  tenderoMs  of  the  Abdomen  in  the 
Mimosis  Decolor,  §  226,  m  distinguished  from  In- 
flamation,  by  the  same  means  as  pain  and  tender- 
ness of  the  side,  §  283.  I  shall  illustrate  the  sudden 
or  urgent  attack  by  the  following  case^  and  shall  af- 
terwards give  the  characteristics  of  the  case  of  Pro- 
tracted Inflammation  of  the  Peritonaeum. 


287.  Case  LXXIIT.    Mrs.  B.  of  S.  aged  45,  and 
mother  of  five  children,  has  been  affected  with  some 

0  *  See  the  treat ;«?  on  DiARTre^is,  Part.  IT,  §  1?>. 


THE  DIAGNOSIS.  161 

part  of  the  following  symptoms  for  several  years,  and 
especially  since  the  death  of  Mr.  B.  three  years  ^go. 
—  ihe  countenance  is  pale,  wan,  and  yellowish  ;  the 
'  prolahia  pale  ;  the  tongue  slightly  lohulated,  and  clean  ; 
the  bowels  irregular. — On  heptemher  the  3rd,  1818,' 
»he  was  seized  w  ith  hurry  and  difficulty  in  breathing  ; 
with  pain  in  the  bowels,  much  tenderness  of  the  ab- 
domen under  pressure,  and  with  discharges  of  blood. 
The  affection  was  completely  removed  by  calomel, 
senna,  and  sulphat  of  magnesia.  A  little  ptyalism 
was  induced,  and  the  patient  abandoned  all  her  med- 
icines. The  affection  again  returned.  A  grain  of 
opium  was  prescribed  for  the  symptoms,  which  in- 
duced great  sickness  and  restlessness.  Calomel  was 
again  resorted  to ;  and  a  cautious  course  of  this  and 
other  purgative  medicines,  has  entirely  removed  the 
more  urgent  complaints,  and  greatly  improved  the 
general  appearance,  health,  spirits,  and  strength. 

288.  Protracted  Inflammation  of  the  Peritonaeum 
is  denoted  by  an  expression  of  pain,  of  suffering,  and 
of  disease,  in  the  countenance,  attended  by  loss  of 
flesh  5  the  skin  in  general  is  little  affected,  except  at 
last,  when  it  is  modified  by  a  state  of  chronic  symp- 
tomatic fever  ;  there  is  a  slow,  but  progressive  ema- 
ciation ;  the  pulse  becomes  very  frequent ;  there  is  a 
diffused  tenderness  over  the  abdomen  ;  there  are  at- 
tacks of  retching  and  vomiting,  of  obstruction  of  the 
bowels,  or  of  diarrhoea. —  The  progress  of  the  case  is 
various  :  it  is  sometimes  protracted  for  eight,  or  ten 
w 


16^  THE  MIMOSIS  DECOLOR. 

months,  or  even  longer,  when  there  are  complete  hec- 
tic and  atrophy.^ — In  the  Protracted  Pain  and  Ten- 
derness of  the  Ahdomen  ioi  the  Mimosis  Decolor,  there 
is  often  a  loaded  state  of  the  Colon,  and  sometimes  a 
perceptible  tumor  in  the  right  or  left  side  or  iliac  re- 
gion, or  in  both,  from  the  remora  of  faeces  in  the 
course  of  this  intestine  ;  and  there  is  constipation,  or 
diarrhoea,  and  sometimes  Melsena  or  discharges  of 
blood,  sometimes  florid,  sometimes  dark,  and  some- 
times tar- like,  t 

289.  Melaeua,  §  S26,  has  frequently,  but  by  no 
means  exclusively,  occurred  in  married  persons  af- 
fecteil  with  the  Mimosis  Decolor.  I  shall  illustrate 
the  subject  by  the  following  cases  : — 

290.  Case  LXXIV.  Mrs.  E.  of  L.  aged  40,  and 
mother  of  a  iamily.  I  was  consulted  by  this  lady^ 
who  resides  fifteen  miles  from  Nottingham,  on  the 
following  occasion  : — She  had  been  seriously  indis- 
posed for  some  weeks,  during  sofiie  part  of  which  pe- 
riod she  had  kept  her  bed,  and  had  become  extremely 
weak,  and  had  lost  flesh ;  the  most  urgent  complaints 
w  ere  great  irregularity  and  intermission  of  the  pulse, 
with  a  severe  sense  of  fluttering  in  the  chest,  which 

*  The  subject  of  Ixsi»ious  Inflaxmatiox  of  the  BxcEPaALOX,  or  the 
PiECBA,  AUB  OF  THE  Pebitosjeum,  WHS  intended  to  have  been  illustrated  bj 
Cases  in  a  note  in  this  place.  But  it  is  found  too  extensive.  It  is  therefore  reser- 
ijed  for  a  future  opportuuity. 

-j-  See  Miss  G*8  case,  §  246. 


THE  DIAGNOSIS.  1(].S 

liad  led  to  the  suspicion  of  Organic  Disease  of  the 
Heart  together  with  diarrhoea  and  Jlelcena. — On  in- 
quiring into  the  History  of  the  affection^  1  found  that 
Mrs.  E.  had  lost  her  complexion,  appearance  of 
healthy  strength,  and  some  flesh,  four  or  five  years  pre- 
viously, and  that  the  irregularity  of  puls€,  and  the 
melsena,  were  not  new  complaints.  The  countenance 
was  pale  and  yellowish  ;  the  prolabia  and  gums  pale ; 
the  tongue  formed  into  lobules  ;  the  hands  and  gene- 
ral surface  pale  and  dry.  There  was  some  affection 
of  the  head  and  a  degree  of  hurry  in  the  respiration, 
with  some  cough. — This  affection  was  soon  relieved 
l)y  calomel  and  gentle  purgative  medicines  ;  and  the 
general  health  and  the  complexion  have  been  greatly 
improved  by  a  continuance  of  the  same  plan  under 
proper  regulations,  and  with  strict  attention  to  diet, 
air,  and  exercise. 

291.  Case  LXXV.  Mrs.  H.  aged  55,  and  the 
mother  of  a  family,  became  indisposed,  from  grief  and 
anxiety,  about  three  years  ago.  The  causes  of  her  com- 
plaints were  repeated,  and  her  indisposition  became 
gradually  more  and  more  serious.  8he  lost  her  com- 
plexion and  flesh,  became  subject  to  cedematous  sv»  el- 
ling  of  the  ankles  and  legs,  to  vertigo,  fluttering  and 
palpitation,  and  to  a  state  of  diarrhoea  attended  with 
discharges  of  blood,  with  tenesmus  or  forcing,  and 
with  prolapsus  ani.  Once  the  oedema  assumed  the 
more  serious  form  of  anasarca,  but  was  much  dimin- 
ished, whilst  the  general  health  was  much  restored, 


16*  THE  MIMOSIS  DECOLOR. 

by  along  journey.     For  the  affection  of  the  bo\vels> 
IVivs.  H.  was  obliged  to  have  recourse  to  the  tinctura 
opii.     55Juch  was  nearly  the  state  of  her  complaints 
about  a  year  ago.      The  countenance  was  yellow  and 
icterode  :  the  integuments  yellowish,  puffy  and  opaque; 
the  conjunctivge  quite  white.      The  pulse  was  a  little 
frequent.      Not  a  day  passed  without  the  painful  and 
wcalvening    attack  of  looseness,    with   discharges  of 
blood,  and  descent  of  the  rectum.      She   was  recom- 
mended small   doses  of  the  pil.  hydrarg.  and  of  rhu- 
barb ;  and   to  diminish  the  quantity  of  laudanum  as 
much  as  possible.      By  perseverance  in  this  mode  of 
treatment,  the  general   health  and  strength  are  much 
improved,  and  all  the  other  symptoms  mucli  mitigated  ; 
she  has  been  enabled  almost  to  leave  off  her  lauda- 
num, to  walk  a  distance  of  three  miles  to  Nottingham 
and  back   again  in  one  day,  and  to  superintend  her 
domestic  concerns  with   far  more  ease  and  comfort. 
The  complexion  is  still  yellowish  :  but  there  is  a  little 
return  of  colour  in  the  cheeks  ;  and   her  amendment 
continues  obviously   progressive. —The  prolapsus  ani 
had  taken  place  previously  to  the  present  complaint, 
but  was  very  much  augmented  by  it.      She  had  also 
suffered  from  several  miscarriages. 

292,  Menorrhagia  and  Leucorrhcea  are  frequent 
occurrences  in  the  {♦'iimosis  Decolor ;  they  are  fre- 
quently ihe  concealed  cause  of  the  inefficacy  of  reme- 
dies for  the  original  affection,  and  of  a  most  distress- 
ing weakness  and  pain  experienced  in  the  loins. — 


THE  DIAGNOSIS.  163 

This  affection  also  occurs  from  some  other  causes,  as 
frequent  labours,  or  abortions,  too  long  lactation,  or 
other  sources  of  debility  ;  it  then  appears  to  induce  the 
pain  and  weakness  of  the  back  just  mentioned,  flut- 
tering, nervousness,  and  other  symptoms  of  Mimosis. 
It  is  removed,  I  think,  universally,  by  the  remedy  to 
be  noticed  hereafter. 

293.  Case  LXXVl.  E.  S.  aged  40.  May  3, 1819. 
For  half  a  year  she  has  been  affected  with  menorrha- 
gia  without  intermission.  Before  this  she  was  long 
affected  with  Leucorrhoea.  Both  these  complaints 
have  been  removed  by  the  zinc  lotion  and  opening 
medicine,  which  was  required  by  costiveness.  The 
tongue  was  lobulated  and  she  had  many  of  the  symp- 
toms of  Mimosis, — vertigo,  fluttering,  &c. 

294.  The  subject  of   Hysteric  Affections,  §  226, 
is  reserved  for  the  ensuing  chapter. 


166  THE  MIMOSIS  DECOLOR. 


SECTION  UI.    THE  CAUSES  AND  TREATMENT. 


295.  No  age,  sex,  condition,  ox  mode  of  life,  en- 
joys a  perfect  immunity  from  the  Mimosis  Decolor ; 
but  it  occurs  most  frequently  in  female  youth,  and 
next,  in  women  in  the  decline  of  life. 

296.  The  most  frequent  cause  is  Sedentariness. 
This  affection  is,  therefore,  usually  observed  in  schools, 
in  females  of  a  delicate  mode  of  life,  or  of  a  sedentary 
occupation  or  habit.  The  Mimosis  Decolor  is  the  pre- 
vailing affection  of  those  females  who,  in  this  and 
other  manufacturing  towns,  are  doomed  to  sit  from 
morning  till  evening  at  the  lace-frame,  or  the  tam- 
bour, or  engaged  in  mending,  seaming,  chevening, 
&c. — Servants,  and  especially  house-maids  and  cooks, 
have  also  appeared  to  be  particularly  liable  to  the 
Mimosis  Decolor. 

297.  Confinement  ;  too  long  lactation  ;  fre- 
quent H-EMORRHAGIES  ;  PROTRACTED,  OR,  LONG  CON- 
TINUED    HABITS     OF     MENORRHAGIA, — AND     OF     LEU- 

coRRHCEA  ;  anxiety;  fatigue;  and  loss  of  rest, 
have  also  appeared  to  induce  the  Mimosis  Decolor  in 
persons  more  advanced  in  years. 


THE  TREATMENT.  16? 

29S.  Tt  is  needless  to  say  that,  in  the  treatment, 
it  is  absolutely  necessary  to  avoid  or  obviate  the  causes 
of  the  affection;  otherwise  the  complaint  continues 
progressive,  or  assumes  the  chronic  form. — The  treat- 
ment itself  consists  in  the  administration  of  the  reme- 
dies and  regimen  already  recommended  for  the  Mi- 
mosis  Acuta  and  Chronica,  properly  adapted  to  the 
case  of  the  Mimosis  Decolor.- 

S99.  Five  grains  of  calomel  may  be  given  once  a 
week,  once  in  ten  days,  or  once  a  fortnight.  On  the 
intermediate  days,  a  sufficient,  consistent  al- 
viNE  EVACUATION  must  be  procured  by  pills  of  aloes 
and  rhubarb,  or  by  the  infus.  sennse  with  the  sulphat 
of  magnesia. 

300.  Daily  Exercise, riding  or  walking, 

morning,  noon,  and  evening, — and  a  total  change  of 
Air  and  of  Habits  must  be  strenuously  recommended. 

301,  The  same  attention  to  Diet  is  necessary  a& 
before.  I«ean  mutton,  beef,  or  fowl ;  biscuit ;  tea,  or 
coffee  ;  and  after  a  time,  a  little  ale,  or  negus,  are4h& 
articles  of  diet  principally  to  be  recommended.  Veg- 
etables in  general  should  be  avoided  as  much  as  pos- 
sible, especially  greens,  and  even  bread. 

303.  For  other  observations  on  the  treatment  of  the 
Mimosis  Decolor,  I  must  refer  my  readers  to  the  re- 
marks made  formerly,  §§  158 — 183,  198 — 503,  which 


108  THE  MIMOSIS  DECOLOR. 

will  sufficiently  suggest  what  I  might  add  in  this  place. 
I  have  also  prescribed  the  preparations  of  Iron.  But  as 
they  have  never  been  trusted  to  alone.  1  have  not  been 
able  to  ascertain  precisely  the  effects  of  this  remedy. 

303.  The  Local  Complications  in  the  Mimosis  De- 
color generally  yield  to  the  proper  treatment  of  the 
general  affection^  especially  purgative  doses  of  calo- 
mel. And  this  is  satisfactory,  and  a  coniirmation  of 
the  Diagnosis. 

304.  But  in  dubious  cases,  it  may  be  advisable  io 
employ  remedies  for  the  local  affection  itself,  'i'hese 
consist  of  bleeding,  leeches,  and  blisters,  especially  the 
latter. — in  the  case  of  Affection  of  the  Head,  it  is 
prudent  first  to  bleed  and  apply  a  blister  in  order  to 
remove  the  immediate  attack;  and  to  follow  this 
treatment  by  the  proper  remedies  for  the  Mimosis  De- 
color, by  means  of  which  the  recurrence  of  affection  of 
the  head,  and  of  the  necessity  for  a  repetition  of  the 
former  remedies,  may  in  general  be  obviated, — The 
same  remarks  apply  to  the  Painful  Affection  of  the 
Side  or  Abdomen, — In  the  case  of  Diarrhoea  or  Me- 
Isena,  the  pil.  hydrarg.  and  calomel  afford  the  most 
efficient  remedies ;  they  must,  however,  be  conjoined 
with  rhubarb  or  other  gentle  purgative,  during  the 
intervals  of  giving  the  former  medicines. 

305.  The  remedy  for  Menorrhagia  and  Leucorrhcea 
formerly  alluded  to  is  a  continued  local  application  of 


THE  TREATMENT.  169 

a  solution.of  sulphat  of  zinc,  in  the  proportion  of  from 
one  to  two  drams  and  a  half,  to  a  pint  of  pure  water. 
A  similar  solution  has  long  been  employed  in  cases  of 
Leucorrhoea,  injected  by  means  of  a  syringe.  This 
mode  of  application  I  have  found  altogether  inefficient 
in  protracted  cases  of  the  aftecti;  n  ;  the  application 
being  momentary  only,  the  effect  is  transitory  and  the 
remedy  itself  proves  inefficient.  The  mode  I  have 
adopted,  is  to  direct  the  patient  to  make  a  scroll  of 
linen,  of  a  form  and  bulk  nearly  sufficient  to  fill  the 
vagina  ;  this  scroll  is  then  fully  imbued  with  the  so- 
lution of  sulphat  of  zinc,  inserted,  after  Washing  with 
cold  water,  and  renewed  every  three  hours. 


X 


CHAPTER  IV. 


THE  MIMOSIS  URGENS. 


SECTION  I.    THE  DESCRIPTION. 

306.  I  HAVE  ventured  to  substitute  this  denom- 
ination  for  the  very  objectionable  term,  Hysteria^ 
The  adjective  expresses  that  character  of  hurry,  and 
of  apparently  imminent  danger,  so  usual  in  almost  all 
the  forms  of  this  affection,  •  and  will  be  understood  by 
every  reader  by  being  associated  with  an  English 
word,  to  which  it  gives  origin. 

307.  The  Mimosis  Urgens,  besides  the  character- 
istic just  mentioned,  is  generally  denoted  by  combin- 
ing some  considerable   emotion  of  the  mind,    denoted 

by  SIGHING,  SOBBING,  TEARS,  OR  LAUGHTER,  WITH 
A  SENSE  AND  EXPRESSION  OF  SUFFOCATION,  AND 
WITH  SOME  URGENT  AFFECTION  OF  THE  HEAD,  HEART, 
RESPIRATION,    STOMACH,    OR    MUSCULAR    SYSTEM. 

308.  The  Mimosis  Urgens  most  frequently  occurs 
as  symptomatic  of  the  Mimosis  Decolor,  or  of  the 


THE  DESCRIPTION.  m 

more  continued  form  of  the  Mimosis  Acuta.  But  it 
is  occasionally  induced  by  severe  mental  emotions,  as 
excessive  joy  or  grief ;  and  a  less  curable  form  of  the 
affection  has  been  occasioned  by  surprise,  but  espe- 
cially by  fright. 

309.  Of  the  Mitoosis  Urgens  there  are  three  fortns, 
— the  Mild,  the  Severe,  and  the  Inveterate  ;  and  there 
are  mostnumerons  modifications, 

310.  The  Mild  Form  of  the  Mimosis  Urgens  sub- 
isists  as  a  tendency  to  alternate  high  and  low  spirits, 
to  fits  of  laughter,  to  frequent  deep  sigliing,  and  to 
tears.  A  fit  of  laughter,  or  of  crying,  sometimes 
takes  on  an  aggravated  character ;  the  laughing,  or 
the  sobbing,  becomes  immoderate,  convulsive,  and 
involuntary,  and  there  is  frequently  a  peculiar  spas- 
modic chucking  in  the  throat.  The  countenance 
changes,  being  alternately  flushed,  and  pale,  and  de- 
noting great  anxiety.  There  is  frequently  an  urgent 
difficulty  in  breathing,  with  much  rapid  heaving  of 
the  chest.  Sometimes  a  dry,  spasmodic,  and  violent 
fit  of  coughing  occurs.  There  is  generally  a  sense, 
and  appearance,  and  an  urgent  fear  of  impending 
suffocation.  In  different  instances  there  is  palpitation, 
hiccough,  retching,  or  borborygmus.  The  patient  is 
despondent,  and  aggravates  all  her  sufferings. 

311.  The  severe  Fortii  of  the  Mimosis  Urgens  Con- 
sists in  a  various  attack,  catenation,  or  combination  of 
the  following  symptoms : — 


17^  THE  MIMOSIS  URGENS. 

313.  The  commencement,  course,  or  termination 
of  this  and  indeed  of  every  form  of  the  Mimosis  Ur- 
gens,  is  generally  marked,  and  the  case  distinguished, 
by  the  signs  of  some  inordinate  mental  emotion, — 
joy,  grief,  or  other  affection, — which  constitute  the 
most  characteristic  symptoms  of  this  disorder,  and 
have  appeared  to  be  literally  hysterical, 

313.  The  attack  is  frequently  ushered  m  by  an 
unusual  appearance  of  the  countenance, — a  rapid 
change  of  colour,  rolling  of  the  eyes,  distortion  or 
spasmodic  affection  of  the  face.  The  extremeties  are 
apt  to  become  very  cold. 

314.  A  state  of  general  or  partial,  of  violent  or  of 
continued  convulsion,  or  of  fixed  spasmodic  contrac- 
tion, takes  place,  and  displays  every  possible  variety 
in  mode  and  form. 

315,  The  severe  form  of  the  Mimosis  Urgeus  some- 
times consists  chiefly  in  a  severe,  general  or  partial 
pain  and  throbbing  of  the  head.  Occasionally  this 
pain  is  confined  to  one  particular  spot,  and  is  so  acute 
as  to  have  obtained  the  appellation  of  clavus  hysteri- 
cus. Sometimes  there  is  in  olerance  of  light  and 
noise.  Sometimes  a  state  of  stupor;  sometimes  de- 
lirium, 

316.  The  respiration  is  frequently  much  affected  ; 
— an  oppressive  and  suffocative  dyspnoea  takes  place ; 


THE  DESCRIPTION.  173 

or  the  breathing  is  rapid,  anxious,  and  irregular  ;  or 
variously  attended  with  sobbing,  sighing,  much  rapid 
heaving  of  the  chest,  and  sometimes  with  a  spasmodic 
action  of  the  diaphragm  inducing  a  peculiar  elevation 
of  the  abdomen,  or  an  equally  peculiar  succusory 
movement  of  the  trunk  in  general ;  sometimes  the 
respiration  appears  to  be  suspended  altogether  for 
some  time,  the  pulse  Continuing  to  beat  as  before. 

317.  A  crowing  noise,  or  screaming,  is  apt  to  oc- 
cur in  this  affection.  There  is  occasionally.  Hoarse- 
ness, or  even  an  entire  Loss  of  the  Voice,  continued 
for  some  time. 

318.  There  is  sometimes  a  painful,  violent,  dry, 
hoarse  cough,  continued,  or  recurrent  in  paroxysms, 

319.  There  is  occasionally  acute  Pain  of  the 
Chest  or  Abdomen. 

320.  Palpitation  of  the  heart,  and  syncope  arc 
usual  affections  in  the  Mimosis  Urgens.  The  pulse 
is  otherwise  little  affected. 

331.  There  is  frequently  an  urgent  sense  of  suffo- 
cation, accompanied  with  the  feeling  of  a  ball  ascend- 
ing into  the  throat ;  this  symptom  is  so  peculiar  as  to 
have  obtained  the  denomination  of  globus  hystericus, 
and  is  considered  as  diagnostic  of  this  affection.  Hic- 
cough, and  violent  singultus  ;  retching  and  vomiting: 


174  THE  MIMOSIS  URUENS. 

the  sense  of  a  ball  rolling  within  the  abdomen  5  bor- 
borygmus  ;  a  peculiar,  great  and  sudden  tumidity  of 
the  abdomen,  apparently  from  flatus ;  constipation, 
&c.  are  usual  symptoms  in  the  Mimosis  Urgens,  and 
sometimes  occur  in  paroxysms^  and  sometimes  assume 
a  more  continued  form. 

3S3.  There  is  frequently  difficulty  or  retention  of 
urine,  succeeded  by  a  very  copious  flow  of  limpid 
urine. 

3S3.  The  Inveterate  Form  of  the  Mimosis  Urgens, 
— id  enim  vitium  quibusdam  feminis  crebro  revertens 
perpetuum  evadit, — consists  sometimes  in  an  almost 
perpetual  agitation  of  some  part  of  the  body,  the 
limbs,  the  respiration,  the  throat,  or  the  stomach  ; — 
and  sometimes  in  a  state  of  continued  contraction  of 
the  hand  or  foot,  or  of  some  other  part.  In  different 
instances  too,  there  is  a  continued  stj^te  of  nervousness 
or  agitation  from  tbe  slightest  noise  or  otlicr  cause, 
— of  paralytic,  epileptic,  or  spasmodic  disease^— or  of 
imbecility  of  the  mind. 

3^4.  The  attention  has,  I  think,  been  too  exclu- 
sively directed  to  the  paroxysm  of  convulsion  in  this 
affection.  Some  of  the  other  varieties  in  the  attack 
of  the  Mimosis  Urgens,  are  almost  equally  frequent. 
This  affection  is  characterized,  indeed,  by  affecting 
in  the  same,  or  in  different  instances,  singly  or  con- 
jointly,    ALL     THE   SEVERAL    SYSTEMS    whlch    COnsti- 


THE  DESCRIPTION.  175 

tute  the  human  frame  ; — the  organs  of  animal  and  of 
organic  life  ; — the  different  sets  of  muscles,  voluntary, 
involuntary,  mixed,  and  sphincter ; — the  faculties  of 
the  mind,  and  the  emotions  of  the  heart ; — the  func- 
tions of  the  head,  the  heart,  the  stomach,  &c.  It  is 
in  thus  viewing  the  Mimosis  Urgens,  that  the  diag- 
nosis is  often  formed  between  its  different  and  very 
various  attacks,  and  other  affections  iiaviug  a  different 
origin,  but  of  which  it  as  the  imitator — nam  nullos 
fere  non  cemulattirjdx  lis  affectibus  quibus  atteruntur 
miseri  mortales.* 

S25.  The  varieties  of  the  Mimosis  Urgens  are 
more  numerous  even  than  those  of  the  other  forms  of 
Mimosis.  They  are  also  more  acute,  urgent^  and  vi- 
olent.  The  following  list  it  is  hoped,  will  be  found 
tolerably  complete : — 

1.  CONVULSION. 

2.  PAIN    OF    THE    HEAD. 

3.  DELIRIUM. 

4.  STUPOR. 

5-.    PAIN    OF    THE    CHEST. 

6.  DYSPNOEiis. 

7.  VIOLENT    COUGH. 

3.    SUSPENDED    RESPIRATION. 

%    A    PAINFUL     AFFECTION    OF    THE    DIAPHRAGM- 

10.  IMITATION    OF    CROUP  ;    AND    OF 

11.  IMPENDING    SUFFOCATION. 

12.  PALPITATION   OF   THE    HEART. 

13.  SYNCOPE. 

*  Vide  Sydenham:  de  Affectione  Hysterica. 


176  THE  MIMOSIS  URGENS. 

14.  PAIN    OF    THE    ABDOMEN. 

15.  HICCOUGH. 

16.  RETCHING    AND    VOMITING. 

17.  DYSURY. 

18.  RETENTION    OF    URINE. 

19.  APPARENT    PARALYSIS. 

20.  TRISMUS. 

21.  TETANUS. 

22.  CONTRACTED    HAND. 

23.  DISTORTED    FOOT. 

24.  TWISTED    LEGS.t 

326.  The  attack  of  the  Mimosis  Urgens^  iindev 
almost  every  modification,  is  acute,  sudden,  and  hur- 
ried ;  the  diagnosis  must  therefore  be  instituted  be- 
tween this  disorder  and  those  morbid  affections  which 
occur  suddenly  or  in  paroxysms.  The  diagnostics 
will  be  attempted  in  the  ensuing  section. 

327.  It  appears  needless  to  exemplify  the  Mild 
Form  of  the  Mimosis  Urgens,  §  310. 

328.  The  Severe  Form  of  this  affection,  §§  311 
— 322,  is  exemplified  in  almost  all  its  varieties,  by 
the  following  Case,  continued  from  §  251  :— 

329.  For  some  time  there  were  returns  every 
morning,  of  violent  pain  of  the  head,  with  intol- 
erance of  light  and  sound, — of  which  she  is,  indeed 
generally  very  susceptible.  For  several  months,  there 
were    evening  returns  of  delirium,   with   incessant 

f  See  Section  If, 


THE  DESCRIPTION.     .  177 

talking,  singing,   crying,  or  laughing, — usually  end- 
ing in  sleep.      A  number  of  times,  but  iiregularly, 
there  were  attacks  of  stupor,  from  which  she  could 
not  be  roused,   and  which  would  continue  during  two 
hours.      There   has   often    been  pain    about    the 
STERNUM,  spreading  over  the  chest  and  to  the  shoul- 
der points,    apparently    requiring,    and    yielding    to 
bleeding  from  the  arm.     With  pain  of  the  chest,  there 
has  often  been  very  rapid,   spasmodic   breathing, 
demanding  free  exposure  to  the   fresh  air  at  an  open 
window.     At  other  times,  there  has  been  an  apparent 
suspension  of  respiration,  durihg  many  minutes, 
the    pulse    still,    however,    beating;    the    breathiug 
gradually  returned  with  a  sort  of  crowing  noise  like 
the  hooping  cough.     At  one  period  there  Avere  even- 
ing   returns    of    violent  and    incessant  coughing, 
which  once  continued  from  7  p.  m.  till  3.  a.  m.  with- 
out intermission ;  the  cough  ceased  gradually  and  at 
length  seemed  scarcely  to  be  a  cough  :  it  was  relieved 
by  bleeding,  laudanum,  breathing  the  vapour  of  hot 
water,  &c.      There   has  been  palpitation  of  the 
heart,  but  not  in  violent  attacks.      There  has  not 
been  much  fainting  affecting  the  pulse,  except  from 
bleeding.     For  many  weeks  there  have  been  constant 
sickness,  vomiting,  and   irritability  of  the  sto- 
mach, every  thing  taken  being  immediately  rejected. 
For  a  few  times,  there  has  been  Violent  hiccough  ; 
this  was  arrested  by  a  preparation   of  opium  termed 
the  black  drop.     There  has  ever  been  great  consti- 
pation.     Once   there    were  the    symptoms    of    in- 

Y 


178  THE  MIMOSIS  URGENS. 

FLAMMATioN  IN  THE  ABDOMEN^  Avitli  great  ten- 
derness under  pressure.  There  has  sometimes  been 
complete  Opisthotonos,  the  body  being  drawn  and 
suspended  on  the  occiput  and  toes  for  several  minutes  ; 
then  it  would  be  drawn  in  a  variety  of  other  difterent 
Mays.  Inhere  have  been  general  and  violent  con- 
vulsions of  the  body.  There  has  often  been  Lock- 
ed-jaw, — once  for  eight  weeks  together,  and  several 
times  for  shorter  periods ; — the  under  lip  is  then  some- 
times drawn  between  the  teeth  and  bitten.  The 
hands  are  often  clenched,  and  the  limbs  drawn  in  a 
twisted  manner  round  each  other.  There  has  been  a 
loss  of  sight,  of  hearing,  and  of  the  use  of  some  of  the 
limbs.  The  catheter  was  daily  used  for  retention 
of  urine  for  many  months,  but  at  length  it  became 
unnecessary.  She  has  twice  complained  of  pain  of 
the  spine  about  the  loins,  which  has,  like  the  other 
symptoms,  disappeared  after  a  time. — From  a  perusal 
of  this  deplorable  list  of  complaints,  the  young  stu- 
dent will  be  prepared  what  to  meet  in  similar  cases 
of  Mimosis  Urgens. 

330.  The  Inveterate  Form,  §  323,  is  also  illus- 
trated by  the  same  case,  for  it  has  at  length  assumed 
that  form.  The  following  case  amongst  numerous 
others,  also  presents  an  example  of  this  stage  of  this 
singular  affection  : — 

331.  Case  LXXVIT.     M.  H.  aged  30.     Septem- 
ber  I6th,  1813.      Her  mother  states  that  her  com- 


"THE  DESCRIPTION.  i^O 

plaint  began  fifteen  years  ago,  and  that  during  the 
Isisifive  years  she  has  been  unable  to  rise  unassisted 
from  her  bed.  During  the  whole  of  this  period  she 
has  been  subject  to  hsematemesis,  retching,  and  vomit- 
ing, and  to  constipation  of  the  bowels. — At  present 
there  are  great  nervousness  ;  starting  from  the  slight- 
est noise ;  agitation  on  the  approach  of  a  stranger ; 
general  rapid  and  forcible  tremor,  so  that  the  pulse 
can  scarcely  be  felt ;  and  an  almost  similar  afl'eciiou 
of  the  respiration  ;  there  is  the  strangest  alternation 
of  spasmodic  heaving  of  the  chest  and  protrusion  of 
the  abdomen ;  the  nostrils  and  the  head  are  moved  at 
each  respiration  ;  there  is  often  retching ;  aud  fre- 
quently retention  of  urine.  The  state  of  agitation  is 
permanent.  The  aflection  is,  at  different  times,  at- 
tended with  pain  of  the  head,  and  a  sense  of  uneasi- 
ness about  the  throat,  and  at  the  scrobiculus  cordis^ 


18a  THE  MIMOSIS  URGENS. 


SECTION  If.    THE  DIAGNOSIS  WITH  CASES. 


83^.  The  cases  of  the  Mimesis  Urgens  requiring 
to  be  discrimioated  from  other  morl)id  affections,  will 
fee  pretty  fully  understood  on  a  perusal  of  the  list 
given  §  355,  The  Diagnosis  is  founded  partly  on  the 
peculiar  and  different  appearance  of  the  particular 
cases  of  the  i/iimosis  Urgens  themselves ;  and  partly 
en  the  precursory,  concomitant,  or  successive  occut- 
rence  of  some  unequivocal  symptom  of  the  Mimosis 
Urgens,  and  especially  of  the  appearances  of  mental 
emotion,  &c.  noticed  §  312,  and  of  hurry  and  appa- 
rent urgency  of  complaint  in  general. 

333.  It  is,  in  particular,  in  this  manner  that  the 
paroxysm  of  Convulsion  in  the  Mimosis  Urgens,  §314, 
is  to  be  distinguished  from  Epileptic  or  Puerperal 
Convulsion.  The  case  unites  the  appearances  des- 
cribed, §§  314,  316,  &c.  There  is  probably  some 
symptom  of  mental  emotion ;  or  some  appearance  pe- 
euliar  to  the  Mimosis  Urgens,  especially  the  hurried 
and  heaving  respiration  ;  or  some  circumstance  in  the 
History  of  the  attack,  which  may  lead  to  the  Diagno- 
sis. Otherwise  the  physician  must  wait  awhile  and 
watch  the  course  of  the  affection,  and  the  succession 
of  symptoms  ;  in  this  manner  some  symptoms  decided- 


THE  DIAGNOSIS,  WITH  CASES.  181 

ly  peculiar  to  the  Mimesis  Urgens  will  occur  to  prompt 
the  discrimination.  In  the  Epileptic  or  Puerperal 
Convulsion,  there  is  an  absence  of  these  symptoms, — 
of  mental  emotion, — and  of  the  appearances  formerly 
deemed  hysterical,  ^  31S;  and  the  patient  seems  to  be 
rather  a  prey  to  some  power  which  exerts  a  violent 
empire  over  the  source  of  sense  and  muscular  motion. 
The  Mimosis  Urgens  may  excite  alarm  ;  but  the  Epi- 
leptic or  Puerperal  Convulsion  presents  a  far  more 
dreadful  aspect, — the  face  perhaps  becoming  deeply 
flushed  and  livid, — with  foaming  at  the  mouth, — 
more  shocking  distortions  of  the  countenance  and  of 
the  body,  and  a  very  diff'erent,  and  a  more  serious 
affection  of  the  respiration.*  J3y  these  means  these 
affections  will  generally  be  distinguished.  The  stu- 
dent will  do  well  to  study  the  general  aspect  and 
course  of  these  affections,  in  order  to  attain  an  aptness 
in  their  Diagnosis. 

334<.  The  affection  of  the  Head  in  the  Mimosis 
Urgens,  §  S25)  is  exemplified  by  the  following  cases  : 

335.  Case  LXXVIII,  Miss  F.  aged  S3,  the  patient 
whose  case  has  been  already  noticed,  §  239,  became 
affected  on  September  the  Slst,  1818,  with  severe 
pain,  and  throbbing  of  the  head,  with  intolerance  of 
light  and  noise ;  she  was  bled  several  times,  without 
relief.  I  saw  her  on  the  S4th.  The  pain  of  the  head 
still  appeared  to  be  excruciating ;  she  cried  out  on  its^ 

*  See  fuFther  the  treatise  on  IMagxosis,  Part  II,  §§  2('0,  29 1, 


18S  THE  MIiMOSIS  URGENS. 

being  moved  on  the  pillow  by  the  nurse  ;  she  experi- 
enced great  throbbing,  and  intolerance  of  light  and 
noise, — the  curtains  were  drawn,  and  the  bells  in  the 
house  were  ordered  not  to  be  rung.  She  stated  too 
that  she  experienced  some  pain  of  the  left  side.  On 
my  entering  the  room,  there  appeared  a  slight  mental 
aflection,— and  shedding  of  tears.  The  pulse  was 
from  110  to  130.  The  countenance  was  pale  and  ex- 
anguious  ;  the  hands  pale,  delicate,  and  puffed.  There 
was  a  degree  of  anxiety  or  hurry.  The  motions  had 
been  scanty,  dark  coloured,  foetid,  and  scybalous. — 
This  affection  yielded  most  favourably  to  purgative 
medicines,  as  already  stated. 

336.  The  occurrence  of  Delirium  is  not  very  fre- 
quent. But  I  have  w  itnessed  it  repeatedly.  The 
case  is  identified  by  the  occurrence  of  some  symptoms 
peculiar  to  the  Mimosis  Urgens.— Delirium  is  noticed 
as  occurring  in  the  case  detailed  §  329. 

337.  The  occurrence  of  Stupor  as  a  form  of  the 
Mimosis  Urgens  is  by  no  means  unfrequent.  The 
case  seems  to  be  of  the  most  urgent  nature. 

338.  Case  LXXIX.  Some  time  ago,  I  received 
an  urgent  call  to  visit  a  poor  woman  said  to  be  in  an 
alarming  state  of  insensibility.  She  was  found  with- 
out sense  or  motion,  but,  in  other  respects,  unaffected 
with  any  particular  symptom.  The  medical  attend- 
ant had  prepared  his  lancet  to  open  a  vein  in  the  arm. 


THE  DIAGNOSIS  WITH  CASES.  i83 

In  a  short  time,  bowever,  the  patient  recovered  her- 
self, and  manifested  symptoms  which  are  peculiar  to 
the  Mimosis  Urgens. — In  another  case  which  occurred 
in  an  aged  woman,  a  vein  had  heen  opened  under  the 
idea  that  she  was  affected  with  Apoplexy.  Some 
symptoms  of  an  anomalous  kind  occurred,  and  she  he- 
came  affected  with  an  unequivocal  attack  of  the  Mi- 
mosis Urgens. — In  similar  or  duhious  cases  it  is  pro- 
per to  wait,  and  observe  the  change  of  symptoms,  and 
particular  inquiry  must  be  made  into  the  History, 
mode  of  attack,  &c.  of  the  affection.  Perhaps  the 
patient  soon  opens  the  eyes,  sighs,  is  affected  with 
dyspnoea,  or  bursts  into  tears.  In  general  some  un- 
expected and  anomalous  symptom  occurs,  to  denote 
the  nature  of  the  affection. 

339.  In  the  Pain  of  the  Chest  in  the  Mimosis  Ur- 
gens, enumerated  §  335,  the  countenance  is  expressive 
of  great  anxiety,  hurry,  and  agitation,  and  the  nostrils 
are  moved  with  rapidity.  The  patient  complains 
much,  manifests  great  impatience,  is  urgent  for  relief, 
and  calls  out  from  the  pain.  The  pain  of  the  chest  is 
extremely  acute,  and  the  part  affected  is  described  as 
excruciatingly  tender  on  being  touched,  and  the  hand 
applied  to  it  is  usually  pushed  rudely  away. 

340.  With  or  without  the  pain  of  chest,  there  is 
often  an  urgent  Dyspnoea ;  the  respiration  is  rapid, 
hurried,  with  much  characteristic  heaving  of  the  chest, 
sometimes  with  great  and  rapid  movements  both  of 


18-4  THE  MIMOSIS  URGENS. 

the  chest   and  abdomen,  and    often  with  a  peculiar 
hissing  noise. 

341.  The  Cough  occurring  as  a  form  of  the  Mi- 
mosis  Urgens,  is  exemplified  §  3S9,  It  occurs  in 
continued  fits  of  incessant  coughing ;  it  is  frequent, 
hoarse,  and  hissing ; — aeger  creberrirae  tussit,  fere 
sine  intermissione,  nihil  prorsus  expectorans. 

342.  Case  LXXX.  A.  T.  aged  2%  has  long 
been  engaged  in  a  sedentary  employment,  and  has 
suffered  from  some  of  the  symptoms  of  the  Mimosis 
Decolor, — paleness,  pain  of  the  side,  dry  cough,  and 
dyspnoea,  and,  when  visited,  was  affected  in  the  fol- 
lowing manner.  There  were  the  utmost  anxiety  of 
countenance,  and  great  general  agitation  and  impa- 
tience. The  breathing  was  hurried,  with  a  dry  hiss- 
ing sound  in  the  throat,  with  much  rapid  heaving  of 
the  chest ;  there  was  a  dry,  hoarse,  frequent,  continued 
cough.  The  pulse  was  little  affected.  The  skin  na- 
tural. The  bowels  constipated. — She  was  soon  re- 
lieved by  an  sether  draught  and  liniment,  and  her 
general  health  was  restored  by  purgatives.  Previ- 
ously to  the  employment  of  these  measures,  she  had 
been  bled  without  any  good  effect,  and  indeed  her 
symptoms  were  aggravated  rather  than  relieved. 

343.  The  case  of  suspended  Respiration  is  noticed 
§  329.  It  is  not  the  least  urgent  of  the  forms  of  this 
affection. 


THE  DIAGNOSIS  WITH  CASES.  185 

341^.  The  painful  aflPection  of  the  Diaphragm  in 
the  Mimosis  Urgens  is  attended  by  the  most  acute 
pain  in  the  epigastric  region,  extending  to  each  side 
along  the  false  ribs,  and  to  the  back ;  it  is  augmented 
occasionally  by  moving,  or  by  the  action  of  the  dia- 
phragm in  respiration,  and  causes  the  patient  to  cry 
out;  the  respiration  is  irregular,  perhaps  performed 
by  the  chest  alone  ;  the  nostrils  move,  the  face  is  some- 
times flushed,  and  there  is  often  shedding  of  tears. 

345.  These  cases  are  distinguished  from  Inflam- 
mation, by  the  History, — the  occurrence  of  symptoms 
peculiar  to  the  Mimosis  Urgens,— the  mode  of  attack 
which  is  sudden, — and  the  general  aspect  of  the  case 
which  is  hurried  and  urgent, — contrasted  with  the 
character  of  Inflammation  already  given  §  ^83 . 

346.  The  Imitation  of  Croup  by  the  Mimosis  Ur- 
gens takes 'place  in  such  a  manner  as  to  deceive  a 
cursory  observer.  The  respiration  and  the  cough  have 
precisely  tlie  character  of  these  symptoms  as  occur- 
ring in  Inflammation  of  the  Trachea.  It  is  by  in- 
quiry, waiting,  and  by  cautiously  observing  the  case, 
that  the  Diagnosis  is  to  be  instituted.  On  inquiry, 
the  attack  will  probably  be  found  to  have  been  mark- 
ed by  some  symptom  or  character  of  the  Mimosis 
Urgens;  or  by  waiting,  some  such  symptoms  may 
occur  to  develope  the  mystery.  The  case  is  sometimes 
soui'gent  as  apparently  to  demand  an  operation  to 
prevent  an  impending  suffocation.* 

*  See  also  Mr.  ChuHes  Bcirs  Reports,  Vol.  1.  p.  40. 
Z 


186  THE  MIMOSIS  URGENT. 

347.  Case  LXXXI.  In  a  young  woman  aged  15^ 
tlic  first  symptoms  which  arrested  the  attention  was 
a  stridulous  sound  of  the  respiration ;  and  circum- 
stances conduced  to  render  an  attack  of  an  inflamma- 
torjf  nature  probable,  bhc  had  been  conveyed  through 
the  cold  air,  and  appeared  to  be  livid  from  cold.  On 
being  seen  in  bed,  however,  the  nature  of  the  disease 
became  obvious,  from  the  presence  then,  of  globus, 
from  th-e  History,  by  which  it  was  ascertained  that 
other  symptoms  of  the  Mimosis  Urgens  liad  occurretl, 
and  from  the  absence  of  any  affection  of  the  pulse. — 
The  patient  was  speedily  relieved  by  the  operation  of 
a  purgative  medicine. 

318.  Palpitation  and  Syncope  in  the  Mimosis  Ur- 
gens are  distinguished  on  the  same  principles  of  ob- 
serving the  History  of  the  case,  assisted  by  the  ob- 
servations made  §  IO7. 

349.  The  Pain  of  the  Abdomen  in  the  Mimosis 
Urgens  is  attended  with  great  urgency  of  complaint; 
much  anxiety  and  suffering ;  an  extreme  tenderness, 
to  the  slightest  touch,  rather  than  under  pressure  ;  a 
hurried  and  irregular  state  of  breathing,  &c.  The 
countenance  is  expressive  of  an  urgent  anxiety ;  the 
patient  is  restless,  impatient,  and  irascible,  and  pushes 
the  hand  although  gently  applied  to  the  abdomen 
rudely  away  ;  the  general  surface,  and  the  pulse  are, 
at  the  same  time,  little  affected  ;  there  is  sometimes 
vomiting,  or  a  sort  of  retching  :  the  bowels  are  gene- 
rally  constipated. 


THE  DIAGNOSIS,  WITH  CASES.  18/ 

ii50.  Case  LXXXII.     M.  W.  aged  35,  aMd  cor- 
pulent.    She  has  several  times  been  suddenly  attacked 
with  the  following  affection.     She  complains  of  great 
pain  and  tenderness  over  the  abdomen  ;  but  she  mani- 
fests a   tendency  to  exaggerate  all   her  comphiiuts, 
which  are  stated  with  a  degree  of  instance  and  impa- 
tience not  observed  in  inflammation.     She  refuses  to 
allow  any  examination  of  t1ie  abdomen,  pushing  the 
hand  rudely  away.     There  is  also  a  degme  of  hurry 
in  the  breathing.      The  manner  is  altogether  different 
from  that  of  a  patient  affected  with  inflammation.* — 
To  these  symptoms,  others  peculiar  to  the   Mimosis 
IJrgens  succeed. — The  patient  was  effectually  relieved 
by  the  operation  of  a  purgative  medicine. 

351.  The  Hiccough  or  the  Retching  is  sometimes 
of  the  most  violent  kind,  and  is  apt  to  be  loog  con- 
tinued. • 

353.  The  Dysury  or  retention  of  Urine  is  very 
common  as  a  form  of  the  Mimosis  Urgens.  Its  du- 
ration is  usually  short.  But  it  has  continued  occa- 
sionally for  a  long  period ;  see  §  3S9.  It  is  distin- 
guished by  being  combined  with  other  jsymptoras  of 
this  affection. 

353.  A  partial,  but  transient  Paralysis  of  some  of 
the  limbs,  §  325,  has  occasionally  occurred  in  the 
Mimosis  Urgens. 

*  See  the  Ircalise  on  Diaoxosis,  Piiit  JI.  §  Ifii. 


18^  THE  MIMOSIS  URGENS. 

354.  Trismus,  Tetanus>  Clenched  Hand,  or  Con- 
tracted Foot,  §^  325,339,  are  not  uncommon  as  forms 
of  the  Mirao^is  Urgens.  Tliese  affections  generally 
occur,  cease,  and  recur  suddenly  and  unexpectedly ; 
but  they  are  often  of  considerable  duration,  and  some- 
times even  appear  to  induce  a  partial  dislocation, 

355.  Cases  LXXXIII.  and  LXXXIV.     C.  W. 

aged  20.  April  10th,  1812.  She  has  been  affected 
with  symptoms  of  the  Mimosis  Urgens,  and  for  many 
weeks,  with  Locked  Jaw. — S.  W  aged  18.  Septem- 
ber 15th,  1813,  became  affected  with  tlie  Mimosis 
Urgens  some  time  ago,  from  fright.  She  describes 
the  globus  and  the  fit  of  convulsion  as  having  occur- 
red repeatedly — At  present  the  muscles  of  the  face  are 
drawn  into  a  forcible  contraction,  inducing  sharpness 
and  elevatfon  of  the  nostrils.  For  many  weeks  there 
have  been  locked  J#v,  and  Locked  Hands  ;  the  arms 
are  affected  with  continued  spasm,  press  forcibly 
against  the  side,  and  induce  great  tenderness  ;  the 
thighs  are  also  affected  in  a  similar  manner  ;  they  are 
bound  down  by  means  of  the  sheet, — otherwise  they 
would  spring  forcibly  upwards  ;  the  patella  is  im- 
moveable :  the  toes  are  drawn  forcibly  towards  the 
soles  of  the  feet. 

356.  These  affections  are,  like  so  many  other  forms 
of  the  Mimosis  Urgens,  illustrated  by  §  32^.  I  think 
them  very  common  in  protracted  cases  of  this  disor- 
der, and  could  add  many  other  instances  if  necessary. 


THE  DIAGNOSIS,  WITH  CASES.  im 

357.  All  these  forms  of  the  Mimosis  Urgens  are 
alike  distinguished  by  the  characters  given  §^  1^  S, 
307?  and  313, — by  hurry  and  by  urgency.  The  oc- 
currence of  these  symptoms  in  other  forms  of  the  Mi- 
mosis Urgens,  which  have  possibly  been  omitted  here, 
may  lead  to  the  identification  of  the  affection ;  for  I 
cannot  hope  that  the  list  of  the  various  forms  of  the 
Mimosis  Urgens  given  §  3S5,  is  absolutely  complete 
or  even  comprehends  all  the  important  cases  of  this 
multiform  disorder. — Dies  quidem  me  deficeret,  si 
omnia  quae  hos  affectus  gravant  symptomata,  enume- 
rare  velira,  tam  diversa  atque  rnvicera  contraria  specie 
variantia,  quam  nee  Proteus  lusit  unquam,  nee  colora- 
tus  spectatur  Chamaeleon.* 

•'Sti)|:3tham  de  AfftcUone  Hysterica,, 


190  THE  MIMOSIS  URGENS. 


SECTION  UI.    THE  TREATMENT 


358.  The  principal  causes  of  the  Miinosis  Urgens 
have  beeu  enumerated,  ^  308.  This  aifection  has 
sometimes  originated  also  from  causes  of  weakness, 
as  too  long  lactation; — and  from  fatigue,  anxiety  and 
watching.  1  have  seen  this  affection  in  the  most  de- 
cided form,  in  the  Male  Sex. 

359.  The  Treatment  embraces  two  objects ;  1.  the 
means  of  affording  immediate  relief  in  the  paroxysm, 
and  2*  the  mode  of  prevention. 

360.  The  attack  of  the  Mimosis  Urgens  is  reliev- 
ed by  aether,  the  sp.  ammonise,,  arom.,  opium,  &c. ;  by 
stimulating  liniments  containing  the  same  substances  ; 
by  fomentation  with  hot  water ;  and,  if  necessary,  by 
blood-letting. 

361.  The  Prophylaxis  consists  in  avoiding  the 
caused,  in  removing  the  original  disorder,  §  308,  if 
the  Mimosis  Urgens  depend  on  this  cause ;  but  espe- 
cially in  the  due  administration  of  Purgative  Medi- 
cines, Diet,  Air,  and  Exercise,  the  principles  of  which 
have  been  already  detailed,  §^  160;  198,  298,  etseqq. 


THE  MiMOSIS  INQUIETA.  191 


rOST^CTllPT. 


In  the  former  edition  of  this  toork  I  inserted  a  sketch  of  an  affection  which  I  de- 
nominated the  MIMOSIS  IJ\rQiUIE.T.1.     I  have  more  recently  publishedx 
a  distinct  Essay  on  that  subject  as  already  stated,  p.  4,  note. 

Of  this  Essay  Revkivs  have  appeared  in  the  Medical  and  Physical  Jovrnat, 
for  July,  1820,  JVo.  257  ;  in  the  Medico-Chirnrgical  Heview,  for  Septeiu-r 
' ber,  1820,  J^To.  2  of  the  Analytical  Series  ;  and  in  the  Medical  Repository , 
for  October  1820,  j\'o.  82,  to -which  the  reader  is  referred,  and  from  \:hich 
the  foUoioing  extracts  are  made, 

*'  There  is  nowhere  else  sucli  an  accQrate  and  lucid  view  of  this  disnrdcr  ns  is 
here  displayed  by  Dr.  Hall,  in  his  general  abstract,  and  in  his  particular  illustra- 
tions, in  the  oases  which  have  occurred  to  his  own  observation.  We  agree  vith  him 
in  his  assertion,  that  "  the  morbid  affection  in  question  constitutes  a  great  propor- 
ion  among  puerperal  cases,  and  a  great  majority  among  the  fatal  ones  ;  aud  of 
these  fatal  ones,  many  are  daily  rendered  so  by  a  mistaken  use  of  the  lancet ;"  and 
we  estimate  the  work  before  us  very  highly,  as  it  miist  lessen  the  frequency  of  stich 
occurrences  in  the  practice  of  those  who  will  peruse  it,  and  who  have  pursued  th(! 
injurious  practice  of  which  the  author  exposes  the  impropriety. 

**The  cases  which  are  related  in  this  wo»k  form  a  highly  valuable  p.-irt  of  it. 
The  descriptions  of  the  malady,  are  given  in  them  in  very  strong  tmits,  and  mark  a 
yare  talent  for  a  clinical  observation.  The  deleterious  effects  of  blood-letting  are 
forcibly  shown,  and  well  contrasted  with  the  treatment  Uie  .author  advises.  The 
infatuation  with  which  some  of  the  practitioners  who  attended  previously  to  Dr. 
Hall  had  used  the  lancet  in  some  of  them,  is  lamentable  ;  and  it  makes  us  particu- 
larly anxious  to  press  nn  the  attention  of  our  readers  this  excellent  addition  to  clini- 
cal medical  literature*' 

The  London  Medical  and  Physical  Journal,  pp.  C4,  G8. 

''The  line  which  separates  spasm  and  irritation  from  inflammation,  is  ofien  sn  ob- 
rcure,  that  the  man  who  could  lay  down  an  accurate  diagnosis  on  this  subject,  would 
do  a  very  great  service  to  the  medical  profession.  We  believe  it  is  a  maxim  pretty 
gcner.illv  acte!  ripon  in  prpctice,  to  treat  a  disease  as  inflammation,  when  we  nrn  in- 
douht  n'iiether  it  be  or  be  not  a  spasm.  This,  upon  the  whole,  is  a  safe  rule  ;  bnt- 
cases  occasionally  present  tht- niselves,  where  it  is  little  less  destructive  fo  bleed  in 
irritJtion,  than  to  stimulate  in  .  ifl.nrnmation.  It  appears  to  be  the  object  of  Dr.  H.d!, 
whose  talent  for  observation  and  power  of  discrimination  are  we!!  known,  to  draw 
the  aitt-ntion  of  his  brethren  to  tlie  above-mentioned  cases,  by  a  plain  record  offafts 
The  motto  wlxKk  he  has  prefixed  to  his  work,  taken  from  Dr.  Dcnman,  is  very  ajt- 
propriate. 


19S  POSTSCRIPT. 

«VVe  thiak  the  profession  is  under  great  obligations  to  Dr.  Hall,  for  drawing 
tlieir  attention  to  those  puerperal  affections  where  irritation  borders  on,  or  even  as- 
sumes the  character  of  inflammation,  and  where  strong  depletory  measures  should 
be  cautiously  put  in  force.  The  only  draw>back  on  the  utility  of  the  publication,  is 
the  danger  of  its  embarrasing  the  inexperienced  practitioner,  where  actual  inflam- 
mation obtains,  combined  with,  or  under  the  guise  of  irritation.  At  all  events,  we 
trust  that  the  work  will  tend  to  effect  tlie  object  designed  by  the  Author,  that  of  ex- 
citing the  minutest  attention  to  the  discrimination  of  diseases." 

The  MecUoo-Chirurgical  Reviewypp.  195,  204. 

"'I'he  lancet  has  been  called,  "a  minute  instrument  of  mighty  mischief;'*  and 
8n  we  are  persuade<l  it  is  in  the  hamis  of  those  •*  bold  and  deciiled"  praclilioners 
who  never  look  aidisea.se  but  through  the  medium  of  inflammuiion,  and  imagine 
that  every  thnig  must  be  safe  while  enough  of  depletion  is  secured  to  iheir  patients. 

*<It  was  w  ilh  much  interest  we  learnt  that  a  formal  denunciation  of  the  inflam- 
matory mania  had  been  made  by  so  able  a  physician  as  the  author  ;  and  after  an  at- 
tentive perusal  of  the  pamphlet  ourselves,  we  can  most  conscientiously,  and  we  do 
,'tar»QSt  earnestly  recommend  its  contents  to  the  consideration  of  our  professional 
brethren.  If  there  are  stdl  any  among  the  number  who  thii»k  undoing  and  unloos- 
ing is  all  that  medicine  demands  or  will  permit,  to  such  we  would  be  more  urgent 
in  ttie  expression  of  onr  wishes  that  they  would  take  Dr.  Hall  as  a  guide  and  pre- 
eijptor." 

t  The  Medical  liepotitory,  JK'o,  82,  p  .299. 


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